MEDICARE: MOUNTAIN VIEW FOOT AND ANKLE INSTITUTE PC

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	3704370501	UT

General Provider Information

NPI Number	:	1477812949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW FOOT AND ANKLE INSTITUTE PC

Provider Business Mailing Address
First Line	:	PO BOX 1249
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-1249
Country	:	US
Telephone Number	:	801-296-2113
Fax Number	:	801-296-1715

Provider Business Practice Location Address
First Line	:	6112 S 1550 E STE 201
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-5007
Country	:	US
Telephone Number	:	801-479-7505
Fax Number	:	801-475-1855

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DAVID B GLOVER
Credential	:	DPM
Telephone Number	:	801-479-7505

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	09/14/2012

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