Provider Demographics
NPI:1134158397
Name:THE FOOT & ANKLE INSTITUTE LLC
Entity type:Organization
Organization Name:THE FOOT & ANKLE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-628-2671
Mailing Address - Street 1:754 SOUTH MAIN
Mailing Address - Street 2:STE 3
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-2671
Mailing Address - Fax:435-634-1601
Practice Address - Street 1:754 SOUTH MAIN
Practice Address - Street 2:STE 3
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-2671
Practice Address - Fax:435-634-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103085213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506164Medicaid
NVNV2504OtherBCBS FEDERAL
NVNV2504OtherBCBS FEDERAL
UTCC6766Medicare PIN
NVCC6766Medicare PIN
NV100506164Medicaid
UT000055307Medicare PIN