Missouri Valley Foot & Ankle Clinic

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

MISSOURI VALLEY FOOT & ANKLE CLINIC

Practice address

606 1St St NW
Mandan, ND 58554-3121

Phone

(701) 751-2641

NPI assigned

Jul 12, 2021

Last updated

Sep 13, 2021By 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

Francisco Antonio Tello, DPMNPI 1376641035

Title

Ceo/DPM

Phone

(701) 751-2641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Missouri Valley Foot and Ankle Clinic PLLC Other name

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Locations

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.

• Francisco A Tello III, DPM

  • Podiatrist
  • Bismarck, ND
  • NPI 1376641035
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1831761634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 1ST ST NW",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585543121",
            "telephone_number": "701-751-2641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 1ST ST NW",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585543121",
            "telephone_number": "701-751-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI VALLEY FOOT & ANKLE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "TELLO",
        "authorized_official_first_name": "FRANCISCO",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "CEO/DPM",
        "authorized_official_telephone_number": "701-751-2641",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1465351",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Missouri Valley Foot and Ankle Clinic PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Domeinique M Midell-Schiller, RN
• Kathryn L Miller, MS
• Stacey Marie Milton
• Olga A Mindt, QSP
• Veronicah Miruka
• Madonna A. Mitzel, OT
• Jorden Moe
• Renae Moe
• Brenda Molinaro
• Moses Momo

• Podiatric Clinic/Center in Mandan, ND
• Providers in Mandan, ND by specialty
• Podiatric Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.