Provider Demographics
NPI:1699508929
Name:CRESWELL FOOT & ANKLE SURGERY
Entity type:Organization
Organization Name:CRESWELL FOOT & ANKLE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-277-6870
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:SMELTERVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83868-0483
Mailing Address - Country:US
Mailing Address - Phone:801-550-4051
Mailing Address - Fax:208-784-8777
Practice Address - Street 1:858 COMMERCE DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:SMELTERVILLE
Practice Address - State:ID
Practice Address - Zip Code:83868
Practice Address - Country:US
Practice Address - Phone:208-784-8777
Practice Address - Fax:208-784-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty