Organization Name: | TOOELE FOOT & ANKLE CLINIC, INC. |
NPI Number: | 1255509154 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIM ALBERT HALLADAY (PRESIDENT) |
Mailing Address: | 2356 N 400 E Ste 104 Tooele |
State: | UT US |
Postal Code: | 840743409 |
Phone Number: | 4358820711 |
Fax Number: | 4358821778 |
NPI Enumeration Date: | 02/13/2008 |
NPI Last Update Date: | 09/23/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 103966-0501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |