1710159215 NPI number — FOOT AND ANKLE SPECIALISTS, P.C.

Table of content: (NPI 1710159215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710159215 NPI number — FOOT AND ANKLE SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SPECIALISTS, P.C.
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:
1710159215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3805 CUTSHAW AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-359-7412
Provider Business Mailing Address Fax Number:
804-359-7418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7660 E PARHAM RD
Provider Second Line Business Practice Location Address:
MOB1, SUITE 104A
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23294-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-273-1717
Provider Business Practice Location Address Fax Number:
804-273-1834
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COOKUS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
804-273-1717

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0103000739 , 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)





Copyright © 2007-2024 www.npivalidator.com