1285863183 NPI number — HAYDEN FAMILY FOOT AND ANKLE CLINIC, PLLC

Table of content: (NPI 1285863183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285863183 NPI number — HAYDEN FAMILY FOOT AND ANKLE CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAYDEN FAMILY 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:
1285863183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8944 N HESS ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HAYDEN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83835-9183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-762-0909
Provider Business Mailing Address Fax Number:
888-762-0909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8944 N HESS ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HAYDEN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83835-9183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-762-0909
Provider Business Practice Location Address Fax Number:
888-762-0909
Provider Enumeration Date:
07/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HIX
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-879-9029

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  P-200 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8084226 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285863183 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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