Provider Demographics
NPI:1205973401
Name:ALBUQUERQUE FOOT & ANKLE, INC.
Entity type:Organization
Organization Name:ALBUQUERQUE FOOT & ANKLE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:WALSTON
Authorized Official - Last Name:KOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-881-8081
Mailing Address - Street 1:6821 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1410
Mailing Address - Country:US
Mailing Address - Phone:505-881-8081
Mailing Address - Fax:505-883-5997
Practice Address - Street 1:6821 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-881-8081
Practice Address - Fax:505-883-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM291261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6363670001Medicare NSC