1295236776 NPI number — INSTITUTE FOOT & ANKLE PA

Table of content: (NPI 1295236776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295236776 NPI number — INSTITUTE FOOT & ANKLE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOOT & ANKLE 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:
ADVANCED FAMILY FOOT CARE CENTERS
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:
1295236776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23959
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-488-8289
Provider Business Mailing Address Fax Number:
888-987-7129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 BRIGGS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78224-1271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-922-1551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ABDEL-QADER
Authorized Official First Name:
MURAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
708-250-3569

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1660 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 1660 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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