Provider Demographics
NPI:1992495410
Name:FOOT & ANKLE COLLABORATIVE, PLLC
Entity type:Organization
Organization Name:FOOT & ANKLE COLLABORATIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-485-4566
Mailing Address - Street 1:PO BOX 1971
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0034
Mailing Address - Country:US
Mailing Address - Phone:651-485-4566
Mailing Address - Fax:
Practice Address - Street 1:1400 N COIT RD STE 302
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6656
Practice Address - Country:US
Practice Address - Phone:651-485-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, PodiatricGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty