1720251366 NPI number — FOOT & ANKLE HEALTH GROUP PC

Table of content: (NPI 1720251366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720251366 NPI number — FOOT & ANKLE HEALTH GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT & ANKLE HEALTH GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720251366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 N CHARLOTTE STREET
Provider Second Line Business Mailing Address:
SUITE 2C
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19464-3974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-326-4367
Provider Business Mailing Address Fax Number:
610-718-0178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 S LEWIS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYERSFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19468-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-948-8585
Provider Business Practice Location Address Fax Number:
610-948-3550
Provider Enumeration Date:
04/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMUELSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-326-3338

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 423488 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".