MEDICARE: THE FOOT AND ANKLE HEALTH CENTER, 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	213E00000X	Podiatrist		UT

General Provider Information

NPI Number	:	1881644052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FOOT AND ANKLE HEALTH CENTER, 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	:	CREDENTIALING SPECIALIST
Name	:	CLAUDINE BRINKERHOFF
Credential	:
Telephone Number	:	801-627-2122

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/10/2025

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