1205954278 NPI number — FOOT CLINICS LTD, P.A.

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 1205954278 NPI number — FOOT CLINICS LTD, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT CLINICS LTD, P.A.
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:
1205954278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 FORD PKWY
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55116-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-698-8879
Provider Business Mailing Address Fax Number:
651-698-7243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 FORD PKWY
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55116-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-698-8879
Provider Business Practice Location Address Fax Number:
651-698-7243
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-698-8879

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  449 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 59599JU . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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