1861670770 NPI number — ACHILLES FOOT HEALTH CENTER, L.L.C.

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 1861670770 NPI number — ACHILLES FOOT HEALTH CENTER, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACHILLES FOOT HEALTH CENTER, L.L.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:
ADVANCED FOOTCARE SPECIALISTS OF CONNECTICUT L.L.C.
Provider Other Organization Name Type Code:
3
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:
1861670770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473-2343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-239-1119
Provider Business Mailing Address Fax Number:
203-234-1832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-239-1119
Provider Business Practice Location Address Fax Number:
203-234-1832
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUROCHER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER OF PRACTICE
Authorized Official Telephone Number:
203-239-1119

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  00709 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 00709 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2704187 . This is a "UNTIED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004191277 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103244500 . This is a "FEDERAL DOL OWCP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CPD# 1392050 . This is a "AETNA - COVENTRY-FIRST HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 007090 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11066538 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008003227 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO3120 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000709CT01 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2110284 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1271789 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 60353065001 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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