NPIMap

Organization Active NPI

Las Vegas Foot Specialist, Inc

  • Podiatrist
  • Las Vegas, NM
National Provider Identifier
1184632929
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
163 Issued in NM
Legal business name
LAS VEGAS FOOT SPECIALIST, INC
Practice address
109 Railroad Ave
Las Vegas, NM 87701-3853
Phone
(505) 425-9491
Fax
(505) 454-8171
NPI assigned
Aug 4, 2006
Last updated
May 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce A Andersen, DPMNPI 1609960699
Title
President
Phone
(505) 425-9491

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 163 NM Primary

Addresses

Primary practice location

109 Railroad Ave
Las Vegas, NM 87701-3853

Mailing address

109 Railroad Ave
Las Vegas, NM 87701-3853
Phone (505) 425-9491

Other identifiers 3

IdentifierTypeStateIssuer
Q2055MedicaidNM
10478OtherNMPHP
5351OtherNMBC/BS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1184632929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RAILROAD AVE",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877013853",
            "telephone_number": "505-425-9491",
            "fax_number": "505-454-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 RAILROAD AVE",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877013853",
            "telephone_number": "505-425-9491",
            "fax_number": "505-454-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAS VEGAS FOOT SPECIALIST, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-425-9491",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NM",
            "license": "163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q2055",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "10478",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "5351",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.