| Organization Name: | ST. CLOUD FOOT & ANKLE CENTER PA |
| NPI Number: | 1083675458 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WALTER NICHOLAS ELLIS (OWNER) |
| Mailing Address: | 106 Doctors Park St Cloud |
| State: | MN US |
| Postal Code: | 563031207 |
| Phone Number: | 3202515444 |
| Fax Number: | 3206569590 |
| NPI Enumeration Date: | 03/28/2006 |
| NPI Last Update Date: | 01/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |