Area Wide Foot & Ankle Center, P.C.

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

00705 Issued in IA

Legal business name

AREA WIDE FOOT & ANKLE CENTER, P.C.

Practice address

1967 Spruce Hills Dr
Bettendorf, IA 52722-2624

Phone

(563) 441-0117

Fax

(563) 355-7396

NPI assigned

Feb 8, 2008

Last updated

Mar 8, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jim Paul Licandro, D.P.M.

Title

Owner

Phone

(563) 441-0117

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204934400000",
    "number": "1336327642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1967 SPRUCE HILLS DR",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527222624",
            "telephone_number": "563-441-0117",
            "fax_number": "563-355-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1967 SPRUCE HILLS DR",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527222624",
            "telephone_number": "563-441-0117",
            "fax_number": "563-355-7396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AREA WIDE FOOT & ANKLE CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2008-03-08",
        "status": "A",
        "authorized_official_last_name": "LICANDRO",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-441-0117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "IA",
            "license": "00705",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IA",
            "license": "00705",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1197210",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.