Healthcare Provider Details

I. General information

NPI: 1689716664
Provider Name (Legal Business Name): THE FOOT & ANKLE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S MAIN ST SUITE 3
ST GEORGE UT
84770-5504
US

IV. Provider business mailing address

754 S MAIN ST SUITE 3
ST GEORGE UT
84770-5504
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-2671
  • Fax: 435-634-1601
Mailing address:
  • Phone: 435-628-2671
  • Fax: 435-634-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberAR1256064
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEITH R REBER
Title or Position: PRESIDENT
Credential: DPM
Phone: 435-628-2671