1710395140 NPI number — ARCHES FOOT AND ANKLE CLINIC PLLC

Table of content: (NPI 1710395140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710395140 NPI number — ARCHES FOOT AND ANKLE CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHES FOOT AND ANKLE CLINIC PLLC
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:
1710395140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 N 1200 E STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-766-9947
Provider Business Mailing Address Fax Number:
801-766-6022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 N 1200 E STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHI
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84043-2255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-766-9947
Provider Business Practice Location Address Fax Number:
801-766-6022
Provider Enumeration Date:
07/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIANSEN
Authorized Official First Name:
WADE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-766-9947

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  83244110501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com