NPIMap

Organization Active NPI

Rock River Foot & Ankle Clinic, SC

  • Foot & Ankle Surgery Podiatrist
  • Whitewater, WI
National Provider Identifier
1649313578
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
ROCK RIVER FOOT & ANKLE CLINIC, SC
Practice address
1461 W Main St
Whitewater, WI 53190-1568
Phone
(920) 563-2136
Fax
(920) 563-3673
NPI assigned
Feb 14, 2007
Last updated
Nov 1, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
ROCK RIVER FOOT & ANKLE CLINIC, SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 2007

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

Authorized official

Name
Dr. Victor Stephen Soderstrom, D.P.M.NPI 1508810110
Title
President
Phone
(920) 261-9610

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
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

1461 W Main St
Whitewater, WI 53190-1568

Mailing address

101 Oakridge CT
Suite a
Watertown, WI 53094-4100
Phone (920) 261-9610

Other identifiers 1

IdentifierTypeStateIssuer
43264800MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Rock River Foot and Ankle Clinic SC9 organizations share this tax ID, including this one
Part of
Rock River Foot and Ankle Clinic SC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1649313578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OAKRIDGE CT",
            "address_2": "SUITE A",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530944100",
            "telephone_number": "920-261-9610",
            "fax_number": "920-261-9671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901568",
            "telephone_number": "920-563-2136",
            "fax_number": "920-563-3673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK RIVER FOOT & ANKLE CLINIC, SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROCK RIVER FOOT & ANKLE CLINIC, SC",
        "enumeration_date": "2007-02-14",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "SODERSTROM",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-261-9610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43264800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitewater, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.