Advanced Foot & Ankle Clinic LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

ADVANCED FOOT & ANKLE CLINIC LLC

Practice address

300 State Ave
Fairbault, MN 55060

Phone

(507) 334-1951

Fax

(507) 451-5514

NPI assigned

Dec 1, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Barry Alexander Butler, DPM

Title

Partner

Phone

(507) 451-5950

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Advanced Foot Ankle Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Advanced Foot & Ankle Clinic LLC

  • Foot & Ankle Surgery Podiatrist
  • Owatonna, MN
  • NPI 1033156906
  NPD tax ID

Locations

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712880000000",
    "number": "1841697273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 E SCHOOL ST",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550603112",
            "telephone_number": "507-451-5950",
            "fax_number": "507-451-5514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 STATE AVE",
            "city": "FAIRBAULT",
            "state": "MN",
            "postal_code": "55060",
            "telephone_number": "507-334-1951",
            "fax_number": "507-451-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT & ANKLE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-01",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "507-451-5950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767042700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "28485",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "6B282RO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "114357D102",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; 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.