Provider Demographics
NPI:1154382398
Name:ELK RIVER FOOT & ANKLE CLINIC PA
Entity type:Organization
Organization Name:ELK RIVER FOOT & ANKLE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:763-241-4036
Mailing Address - Street 1:554 3RD ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330
Mailing Address - Country:US
Mailing Address - Phone:763-241-4036
Mailing Address - Fax:763-274-1511
Practice Address - Street 1:554 3RD ST NW
Practice Address - Street 2:SUITE 201
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330
Practice Address - Country:US
Practice Address - Phone:763-241-4036
Practice Address - Fax:763-274-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN597213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C963SCOtherBLUE CROSS
MN5C962ELOtherBLUE CROSS
01014725OtherPREFERRED ONE
HP24327OtherHEALTH PARTNERS
MN2700050OtherMEDICA
MN1197340001OtherDMERC
121108OtherUCARE
MN5C962ELOtherBLUE CROSS