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NPI Code Detail

MEDICARE: MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC

MEDICARE: MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician
2363L00000XNurse Practitioner
3213ES0103XFoot & Ankle Surgery Podiatrist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17627130003OTHERIDMEDICARE NSC

General Provider Information

NPI Number : 1578569646
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC
Provider Business Mailing Address
First Line : PO BOX 540610
Second Line :
City : N SALT LAKE
State : UT
Zip : 84054-0610
Country : US
Telephone Number : 801-505-0821
Fax Number :
Provider Business Practice Location Address
First Line : 2909 WASHINGTON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84401-3744
Country : US
Telephone Number : 801-603-3246
Fax Number : 801-797-0235
Authorized Official
Title or Position : DPM
Name : SPENCER BOWEN HENINGER
Credential :
Telephone Number : 435-881-4494
Provider Enumeration Date : 06/23/2005
Last Update Date : 02/21/2025

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Directions to “MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC ” Practice Location

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