Healthcare Provider Details

I. General information

NPI: 1598761090
Provider Name (Legal Business Name): MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S MEDICAL DR STE A
BRIGHAM CITY UT
84302-3119
US

IV. Provider business mailing address

PO BOX 540610
N SALT LAKE UT
84054-0610
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-9700
  • Fax: 435-723-9710
Mailing address:
  • Phone: 801-505-0821
  • Fax: 801-505-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SPENCER BOWEN HENINGER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 435-881-4494