1013918630 NPI number — SALISBURY FOOT & ANKLE CENTER PA

Table of content: (NPI 1013918630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013918630 NPI number — SALISBURY FOOT & ANKLE CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALISBURY FOOT & ANKLE 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:
1013918630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MILFORD ST
Provider Second Line Business Mailing Address:
STE 403
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-6953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-6363
Provider Business Mailing Address Fax Number:
410-546-1463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MILFORD ST
Provider Second Line Business Practice Location Address:
STE 403
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-6953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-6363
Provider Business Practice Location Address Fax Number:
410-546-1463
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-749-6363

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  01253 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 450845 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: T468 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 480029665 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DQ5633 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5283530 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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