1962499285 NPI number — FOOT & ANKLE CARE CENTER PA

Table of content: (NPI 1962499285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962499285 NPI number — FOOT & ANKLE CARE CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT & ANKLE CARE CENTER PA
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:
1962499285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28089 VANDERBILT DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BONITA SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34134-7521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-498-1176
Provider Business Mailing Address Fax Number:
239-498-5877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28089 VANDERBILT DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34134-7521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-498-1176
Provider Business Practice Location Address Fax Number:
239-498-5877
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PALADINO
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-498-1176

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  PO2435 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DH1805 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65364 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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