1205816766 NPI number — FOOT AND ANKLE SURGICAL ASSOC

Table of content: (NPI 1205816766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205816766 NPI number — FOOT AND ANKLE SURGICAL ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SURGICAL ASSOC
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:
1205816766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
Provider Second Line Business Mailing Address:
FOOT AND ANKLE SURGICAL ASSOC
Provider Business Mailing Address City Name:
WESTBROOK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04098-0810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-854-1544
Provider Business Mailing Address Fax Number:
207-854-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
952 POST ROAD
Provider Second Line Business Practice Location Address:
FOOT AND ANKLE SURGICAL ASSOC
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-646-9996
Provider Business Practice Location Address Fax Number:
207-646-9949
Provider Enumeration Date:
01/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRAGG
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
207-854-1544

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  POD1039 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1659479541 . This is a "IND NPI #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 022848 . This is a "ANTHEM MAINE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1205816766 . This is a "GROUP NPI #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 431952200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: MM9150 . This is a "MEDICARE IND PIN" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".