Provider Demographics
NPI:1699096537
Name:FOOT & ANKLE ASSOCIATES OF SIOUXLAND, P.L.C.
Entity type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES OF SIOUXLAND, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:COFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-255-5048
Mailing Address - Street 1:3450 S LAKEPORT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4543
Mailing Address - Country:US
Mailing Address - Phone:712-255-5048
Mailing Address - Fax:712-255-5263
Practice Address - Street 1:3450 S LAKEPORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4543
Practice Address - Country:US
Practice Address - Phone:712-255-5048
Practice Address - Fax:712-255-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA362213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1184655Medicaid
18465Medicare PIN
IA1184655Medicaid