Healthcare Provider Details

I. General information

NPI: 1821492018
Provider Name (Legal Business Name): ARCHES FAMILY FOOT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 EAST 100 NORTH
GUNNISON UT
84634-0702
US

IV. Provider business mailing address

65 EAST 100 NORTH PO BOX 702
GUNNISON UT
84634-0702
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-2130
  • Fax: 435-528-2186
Mailing address:
  • Phone: 435-528-2130
  • Fax: 435-528-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number9114085-0501
License Number StateUT

VIII. Authorized Official

Name: JASON DAVID WAITE
Title or Position: OWNER
Credential: DPM
Phone: 516-506-8839