Provider Demographics
NPI:1881644052
Name:THE FOOT AND ANKLE HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:THE FOOT AND ANKLE HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGEMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-673-7661
Mailing Address - Street 1:955 CHAMBERS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4519
Mailing Address - Country:US
Mailing Address - Phone:801-409-2100
Mailing Address - Fax:801-475-6169
Practice Address - Street 1:955 CHAMBERS ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4519
Practice Address - Country:US
Practice Address - Phone:801-409-2100
Practice Address - Fax:801-475-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000058220Medicare PIN
U99666Medicare UPIN