Provider Demographics
NPI:1700098613
Name:WINONA FOOT CLINIC P.A.
Entity Type:Organization
Organization Name:WINONA FOOT CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-452-7662
Mailing Address - Street 1:350 EAST SARNIA STREET
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987
Mailing Address - Country:US
Mailing Address - Phone:507-452-7662
Mailing Address - Fax:
Practice Address - Street 1:350 EAST SARNIA STREET
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987
Practice Address - Country:US
Practice Address - Phone:507-452-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN380213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN480000292Medicare ID - Type Unspecified
MN0476090001Medicare NSC
MNT39874Medicare UPIN