1760006290 NPI number — MODERN FOOT & ANKLE CENTERS, PLLC

Table of content: (NPI 1760006290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760006290 NPI number — MODERN FOOT & ANKLE CENTERS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MODERN FOOT & ANKLE CENTERS, 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:
1760006290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2680 S VAL VISTA DR STE 177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-909-3700
Provider Business Mailing Address Fax Number:
877-839-9972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S DOBSON RD STE E40
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224-5693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-909-3700
Provider Business Practice Location Address Fax Number:
877-839-9972
Provider Enumeration Date:
06/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LAURINO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-909-3700

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com