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General NPI Number Information
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NPI Number | 1952783920
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PODIATRY
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 653 N TOWN CENTER DR SUITE #118
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City | LAS VEGAS
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State | NV
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Zip | 89144-0514
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Country | US
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Telephone | 702-240-8038
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Fax | 702-363-1079
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Provider Business Mailing Address
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Address Line | 653 N TOWN CENTER DR SUITE #118
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City | LAS VEGAS
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State | NV
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Zip | 89144-0514
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Country | US
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Telephone | 702-240-8038
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Fax | 702-363-1079
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Authorized Official
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Title or Position | PRESIDENT
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Name | JODI SUE POLITZ
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Credential | DPM
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Telephone | 702-240-8038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 9811
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License Number State | NV
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