1356598593 NPI number — PROVIDENCE FOOT & ANKLE CENTERS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356598593 NPI number — PROVIDENCE FOOT & ANKLE CENTERS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE FOOT & ANKLE CENTERS 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:
1356598593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3886 PRINCETON LAKES WAY SW
Provider Second Line Business Mailing Address:
SUITE 140A
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30331-5511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-745-4224
Provider Business Mailing Address Fax Number:
770-790-4752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 MARSHALL RD
Provider Second Line Business Practice Location Address:
WELLNESS CENTER
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-896-3338
Provider Business Practice Location Address Fax Number:
770-790-4752
Provider Enumeration Date:
08/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ATKINSON-SNEED
Authorized Official First Name:
ADRIENNE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-745-4224

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ER0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9277 . This is a "MEDICARE GROUP PTAN FOR SC (PALMETTO GBA)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DQ9090 . This is a "MEDICARE RR (PALMETTO GBA) SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "DME (PALMETTO GBA NSC) GROUP PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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