Provider Demographics
NPI:1700968377
Name:THUNDERBIRD PODIATRY
Entity Type:Organization
Organization Name:THUNDERBIRD PODIATRY
Other - Org Name:SOUTHWEST FOOT AND ANKLE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-938-3600
Mailing Address - Street 1:5620 W THUNDERBIRD
Mailing Address - Street 2:G2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-938-3600
Mailing Address - Fax:602-938-0400
Practice Address - Street 1:5620 W THUNDERBIRD
Practice Address - Street 2:G2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-938-3600
Practice Address - Fax:602-938-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty