Healthcare Provider Details

I. General information

NPI: 1982809703
Provider Name (Legal Business Name): WEST VALLEY FOOT & ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 W 2600 S STE 513
BOUNTIFUL UT
84010-7717
US

IV. Provider business mailing address

513 W 2600 S STE 513
BOUNTIFUL UT
84010-7717
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-9202
  • Fax: 801-966-9839
Mailing address:
  • Phone: 801-292-9202
  • Fax: 801-966-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number781028940501
License Number StateUT

VIII. Authorized Official

Name: DR. CRAIG ALAN MCMANAMA
Title or Position: PRESIDENT DOCTOR
Credential: DPM
Phone: 801-966-3556