Provider Demographics
NPI:1861535767
Name:VERDE VALLEY FOOT AND ANKLE CENTER, LLC
Entity type:Organization
Organization Name:VERDE VALLEY FOOT AND ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROYN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-634-8356
Mailing Address - Street 1:PO BOX 4228
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2616
Mailing Address - Country:US
Mailing Address - Phone:928-634-8356
Mailing Address - Fax:928-639-2777
Practice Address - Street 1:1759 E VILLA DR
Practice Address - Street 2:SUITE 114
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4681
Practice Address - Country:US
Practice Address - Phone:928-634-8356
Practice Address - Fax:928-639-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0604213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5713170001Medicare NSC
AZZ108076Medicare PIN