1750503512 NPI number — FOOT & ANKLE HEALTH CARE SC

Table of content: (NPI 1750503512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750503512 NPI number — FOOT & ANKLE HEALTH CARE SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT & ANKLE HEALTH CARE 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:
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:
1750503512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6707 39 AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-654-9181
Provider Business Mailing Address Fax Number:
262-654-3330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6707 39 AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-654-9181
Provider Business Practice Location Address Fax Number:
262-654-3330
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENGEL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
262-654-9181

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  772025 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA9868 . This is a "RAIL ROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43266500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com