Provider Demographics
NPI:1356385348
Name:SUMMIT FOOT AND ANKLE CLINIC, INC.
Entity type:Organization
Organization Name:SUMMIT FOOT AND ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-251-9112
Mailing Address - Street 1:230 N 1680 E
Mailing Address - Street 2:SUITE I - 2
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2579
Mailing Address - Country:US
Mailing Address - Phone:435-251-9112
Mailing Address - Fax:435-251-9114
Practice Address - Street 1:230 N 1680 E
Practice Address - Street 2:SUITE I-2
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2579
Practice Address - Country:US
Practice Address - Phone:435-251-9112
Practice Address - Fax:435-251-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6044606-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF1798OtherPALMETTO GBA
000058216Medicare PIN