Provider Demographics
NPI:1841324795
Name:HESSE FOOT & ANKLE CLINIC, S.C.
Entity type:Organization
Organization Name:HESSE FOOT & ANKLE CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HESSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:715-514-4706
Mailing Address - Street 1:719 W HAMILTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6970
Mailing Address - Country:US
Mailing Address - Phone:715-514-4706
Mailing Address - Fax:715-514-4708
Practice Address - Street 1:719 W HAMILTON AVE STE A
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6970
Practice Address - Country:US
Practice Address - Phone:715-514-4706
Practice Address - Fax:715-514-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI725-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43221500Medicaid
WI000082327Medicare PIN
WIU61778Medicare UPIN
WI5904570001Medicare NSC