Basic Information
| Provider Information | |||||||||
| NPI: | 1689716664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE FOOT & ANKLE INSTITUTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 754 S MAIN ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847705504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356282671 | ||||||||
| FaxNumber: | 4356341601 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 S MAIN ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847705504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356282671 | ||||||||
| FaxNumber: | 4356341601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | REBER | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4356282671 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | AR1256064 | UT | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.