1588023030 NPI number — 1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, 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 1588023030 NPI number — 1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, 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:
1588023030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23434-4507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-934-0768
Provider Business Mailing Address Fax Number:
757-925-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2240 COLISEUM DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-5903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
579-340-7687
Provider Business Practice Location Address Fax Number:
757-925-1901
Provider Enumeration Date:
02/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAIRMAN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-934-0768

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0103300887 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010316057 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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