Healthcare Provider Details

I. General information

NPI: 1598197857
Provider Name (Legal Business Name): CHRISTENSEN FOOT & ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 E CLARK ST SUITE 220
POCATELLO ID
83201-3357
US

IV. Provider business mailing address

1777 E CLARK ST SUITE 220
POCATELLO ID
83201-3357
US

V. Phone/Fax

Practice location:
  • Phone: 208-235-1777
  • Fax: 208-232-7518
Mailing address:
  • Phone: 208-235-1777
  • Fax: 208-232-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP-166
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberP-166
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberP-166
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberP-166
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP-166
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberP-166
License Number StateID

VIII. Authorized Official

Name: MRS. HUI MIN CHRISTENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-235-1777