AREA WIDE FOOT & ANKLE CENTER, P.C. (NPI# 1336327642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336327642 |
| Entity Type | Organization |
| Organization Name | AREA WIDE FOOT & ANKLE CENTER, P.C. |
| Practice Address |
1967 Spruce Hills Dr Bettendorf IA 52722-2624 |
| Practice Telephone | 5634410117 |
| Practice Fax Number | 5633557396 |
| Mailing Telephone | 5634410117 |
| Mailing Fax Number | 5633557396 |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2008-03-08 |
| Authorized Official Name | DR. JIM PAUL LICANDRO (OWNER) |
| Authorized Official Telephone | 5634410117 |
| Authorized Official Credential | D.P.M. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | 00705 | IA | Podiatric Medicine & Surgery Service Providers |
| Y | 261QP1100X |
Clinic/Center Specialization: Podiatric |
00705 | IA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 1197210 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | AREA WIDE FOOT & ANKLE CENTER, P.C. | 1967 Spruce Hills Drive, Bettendorf, IA 52722 |
| Street Address |
1967 SPRUCE HILLS DR |
| City | BETTENDORF |
| State | IA |
| Zip Code | 52722-2624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629442736 | Alisha Jones Podiatry | Podiatrist | 1967 Spruce Hills Dr, Bettendorf, IA 52722-2624 | 2015-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770198855 | Wellspire-bettendorf LLC | Skilled Nursing Facility | 4699 53rd Ave, Bettendorf, IA 52722 | 2020-09-15 |
| 1558873315 | Erin M Kohrt | Speech-Language Pathologist | 2500 Grant Street, Bettendorf, IA 52722 | 2017-11-01 |
| 1437680295 | Holli Christine Martin | Chiropractor | 3048 Victoria St., Bettendorf, IA 52722 | 2017-03-23 |
| 1598219552 | Alyssa Renee Matz | Counselor | 2435 Kimberly Rd Ste 96, Bettendorf, IA 52722 | 2016-08-08 |
| 1144625021 | Athletico Ltd | Physical Therapist | 3252 Ridge Point, Bettendorf, IA 52722 | 2014-11-04 |
| 1609282862 | Katherine L Browne | Nurse Practitioner | 1351 Kimberly Rd Ste 100, Bettendorf, IA 52722 | 2014-07-09 |
| 1316357494 | Kayla Leigh Ehrman | Family Medicine | 2535 Maplecrest Rd Ste 16, Bettendorf, IA 52722 | 2014-04-29 |
| 1043648454 | Duane Anthony Halbur Jr. | Counselor | 2420 Salem Ct, Bettendorf, IA 52722 | 2013-10-22 |
| 1376881185 | Christopher D Murphy | Physical Therapist | 2300 53rd Ave Ll02, Bettendorf, IA 52722 | 2013-01-29 |
| 1326386574 | Kelly C Harry | Occupational Therapist | 3470 Utica Ridge Road, Suite 4, Bettendorf, IA 52722 | 2013-01-23 |
| Find all providers in zip 52722 | ||||
| Taxonomy Code | 261QP1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Podiatric |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144700220 | Midwest Foot and Ankle Center PC | Clinic/Center | 804 Kenyon Rd Ste 310, Fort Dodge, IA 50501-5746 | 2018-08-17 |
| 1205483765 | Premier Foot & Ankle Surgeons of Iowa Pllc | Clinic/Center | 255 Sw Brookside Dr, Ste 200, Grimes, IA 50111-5244 | 2019-08-20 |
| 1003309865 | Podiatry Specialists of Iowa PC | Clinic/Center | 754 N Center Point Rd, Hiawatha, IA 52233 | 2018-06-07 |
| 1568707446 | Wayne L. Wagoner, Dpm, PC | Clinic/Center | 515 Rosemere Ln, Maquoketa, IA 52060-2615 | 2012-12-04 |
| 1831491182 | Jana Poock Dpm PC | Clinic/Center | 1340 E Hickman Rd, Waukee, IA 50263-8137 | 2010-11-18 |
| 1699935981 | Podiatrists PC | Clinic/Center | 1300 2nd Ave Se, Cedar Rapids, IA 52403-4008 | 2008-06-11 |
| 1285891432 | Randall P Bergen Dpm PC | Clinic/Center | 505 5th St, Suite 714, Sioux City, IA 51101-1500 | 2008-05-16 |
| City | BETTENDORF |
| Zip Code | 52722 |
Please comment or provide details below to improve the information on AREA WIDE FOOT & ANKLE CENTER, P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.