1285993220 NPI number — TORHORST FOOT AND ANKLE CLINIC, SC

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 1285993220 NPI number — TORHORST FOOT AND ANKLE CLINIC, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TORHORST FOOT AND ANKLE CLINIC, SC
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:
6
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:
1285993220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2220 TIMBERVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLOVER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54467-9200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-498-1051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1439 CHURCHILL ST # 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUPACA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54981-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-942-2023
Provider Business Practice Location Address Fax Number:
833-208-5257
Provider Enumeration Date:
05/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TORHORST
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
715-498-6266

Provider Taxonomy Codes

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

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

  • Identifier: 7696990001 . This is a "DME" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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