1447483722 NPI number — FOOT AND ANKLE INSTITUTE, PLLC

Table of content: (NPI 1447483722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447483722 NPI number — FOOT AND ANKLE INSTITUTE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE INSTITUTE, 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:
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:
1447483722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3613 BEAVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50310-3273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-223-5219
Provider Business Mailing Address Fax Number:
515-223-9344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3613 BEAVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50310-3273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-223-5219
Provider Business Practice Location Address Fax Number:
515-223-9344
Provider Enumeration Date:
09/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LA FONTANT
Authorized Official First Name:
RUDOLPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-223-5219

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  00597 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: I7655 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: DS1680 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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