Provider Demographics
NPI:1285452839
Name:NORTHSTATE FOOT & ANKLE SPECIALIST INC
Entity type:Organization
Organization Name:NORTHSTATE FOOT & ANKLE SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-891-3338
Mailing Address - Street 1:1806 FOUNDATION LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9206
Mailing Address - Country:US
Mailing Address - Phone:530-891-3338
Mailing Address - Fax:
Practice Address - Street 1:2216 BUENAVENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3838
Practice Address - Country:US
Practice Address - Phone:530-221-1666
Practice Address - Fax:530-221-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies