Provider Demographics
NPI:1699985945
Name:BLUFFS FOOT CLINIC, INC.
Entity type:Organization
Organization Name:BLUFFS FOOT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:712-323-1418
Mailing Address - Street 1:1816 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3815
Mailing Address - Country:US
Mailing Address - Phone:712-323-1418
Mailing Address - Fax:712-323-0016
Practice Address - Street 1:1816 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3815
Practice Address - Country:US
Practice Address - Phone:712-323-1418
Practice Address - Fax:712-323-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA432213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0257774Medicaid
IAT01342Medicare UPIN
IA0257774Medicaid
IA23445Medicare ID - Type Unspecified