Organization
CHRISTENSEN FOOT & ANKLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HUI MIN CHRISTENSEN (OFFICE MANAGER)
(208) 235-1777
Entity
Organization
Contact information
Practice address
1777 E CLARK ST, SUITE 220, POCATELLO, ID 83201-3357
(208) 235-1777
(208) 232-7518
Mailing address
1777 E CLARK ST, SUITE 220, POCATELLO, ID 83201-3357
(208) 235-1777
(208) 232-7518
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P-166
ID
213EP1101X
Primary Podiatric Medicine Podiatrist
P-166
ID
213ER0200X
Radiology Podiatrist
P-166
ID
213ES0000X
Sports Medicine Podiatrist
P-166
ID
213ES0103X
Foot & Ankle Surgery Podiatrist
P-166
ID
213ES0131X
Foot Surgery Podiatrist
P-166
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1351091
MEDICARE PTAN
—
01
—
4792930001
MEDIARE DME
—
05
—
806402300
—
ID
01
—
P00031188
RAILROAD MEDICARE
—
01
—
P1985
BLUE CROSS OF IDAHO
—
Enumeration date
08/08/2013
Last updated
08/08/2013
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