Healthcare Provider Details

I. General information

NPI: 1811803257
Provider Name (Legal Business Name): FOOT AND ANKLE CENTER OF FARMINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 PLAZA DR
FARMINGTON NM
87402-8216
US

IV. Provider business mailing address

5802 PLAZA DR
FARMINGTON NM
87402-8216
US

V. Phone/Fax

Practice location:
  • Phone: 203-300-6865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN CURTIS
Title or Position: MEMBER
Credential:
Phone: 203-300-6865