East Valley Footcare PLLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

322 Issued in AZ

Legal business name

EAST VALLEY FOOTCARE PLLC

Practice address

6104 E Brown Rd
Suite 102
Mesa, AZ 85205-4953

Phone

(480) 357-4400

Fax

(480) 807-0800

NPI assigned

Aug 17, 2006

Organization subpart

No

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

Authorized official

Name

Charles Connell, DPM

Title

President

Phone

(480) 357-4400

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366675200000",
    "number": "1184737546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6104 E BROWN RD",
            "address_2": "SUITE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054953",
            "telephone_number": "480-357-4400",
            "fax_number": "480-807-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6104 E BROWN RD",
            "address_2": "SUITE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054953",
            "telephone_number": "480-357-4400",
            "fax_number": "480-807-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY FOOTCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2013-04-23",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-357-4400",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "AZ",
            "license": "322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "480032936",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480032937",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Valley Diabetes & Endocrinology PLC
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• East Valley Diagnostics LLC
• East Valley Direct Primary Care LLC
• East Valley Endoscopy LLC
• East Valley Glaucoma Inc
• East Valley Hearing Center Inc
• East Valley Hospice P.L.C.
• East Valley Implant & Periodontal Center
• East Valley Implant and Periodontal PLLC

• Podiatrist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Podiatrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; 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.