1346354354 NPI number — SOLE FOOT AND ANKLE SPECIALISTS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346354354 NPI number — SOLE FOOT AND ANKLE SPECIALISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLE FOOT AND ANKLE SPECIALISTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346354354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85285-7514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-967-6500
Provider Business Mailing Address Fax Number:
480-967-6540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 W THUNDERBIRD RD STE G700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306-4673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-938-3600
Provider Business Practice Location Address Fax Number:
602-938-0400
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
JAY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
602-938-3600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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