1538373261 NPI number — SOUTHERN FOOT & ANKLE CENTER PC

Table of content: (NPI 1538373261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538373261 NPI number — SOUTHERN FOOT & ANKLE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN FOOT & ANKLE CENTER 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:
1538373261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 E 65TH ST
Provider Second Line Business Mailing Address:
#9
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-355-3555
Provider Business Mailing Address Fax Number:
912-355-4499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 E 65TH ST
Provider Second Line Business Practice Location Address:
# 9
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-355-3555
Provider Business Practice Location Address Fax Number:
912-355-4499
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HODGES
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING REPRESENTATIVE
Authorized Official Telephone Number:
912-562-7092

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 480033251 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00812644I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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