Provider Demographics
NPI:1144308321
Name:FOOT AND ANKLE CLINIC LLP
Entity type:Organization
Organization Name:FOOT AND ANKLE CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-235-4274
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-0392
Mailing Address - Country:US
Mailing Address - Phone:715-235-4274
Mailing Address - Fax:715-235-9644
Practice Address - Street 1:201 CEDAR FALLS RD
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1270
Practice Address - Country:US
Practice Address - Phone:715-235-4274
Practice Address - Fax:715-235-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43263800Medicaid
WI43263800Medicaid
WI4585870001Medicare NSC
WI43263800Medicaid
WI=========OtherFEIN