MEDICARE: WASATCH FOOT & ANKLE INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	5461147-0501	UT

General Provider Information

NPI Number	:	1225377930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH FOOT & ANKLE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	945 CHAMBERS ST STE 3
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4583
Country	:	US
Telephone Number	:	801-627-2122
Fax Number	:	801-627-2125

Provider Business Practice Location Address
First Line	:	945 CHAMBERS ST STE 3
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4583
Country	:	US
Telephone Number	:	801-627-2122
Fax Number	:	801-627-2125

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. JASON D CAMPBELL
Credential	:	DPM
Telephone Number	:	515-867-7891

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	02/10/2025

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