Healthcare Provider Details

I. General information

NPI: 1659527893
Provider Name (Legal Business Name): THE FOOT & ANKLE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 FALCON RIDGE PKWY BUILDING 300, SUITE A
MESQUITE NV
89027-8850
US

IV. Provider business mailing address

340 FALCON RIDGE PKWY BUILDING 300, SUITE A
MESQUITE NV
89027-8850
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-7678
  • Fax: 702-346-1623
Mailing address:
  • Phone: 702-346-7678
  • Fax: 702-346-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number78902GR
License Number StateNV

VIII. Authorized Official

Name: MRS. BRENT L DAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-628-2671