1437169075 NPI number — THE FOOT & ANKLE CENTER, PC

Table of content: (NPI 1437169075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437169075 NPI number — THE FOOT & ANKLE CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FOOT & ANKLE CENTER, PC
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:
1437169075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 TOWNE CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 505
Provider Business Mailing Address City Name:
POOLER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31322-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-330-8885
Provider Business Mailing Address Fax Number:
912-330-8858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 TOWNE CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
POOLER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31322-4052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-330-8885
Provider Business Practice Location Address Fax Number:
912-330-8858
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TALARICO
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
912-330-8885

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  945 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 052053396005 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: DF3241 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00355897 . This is a "MEDICARE RAILROAD PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5784660001 . This is a "DMERC MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1831106988 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10071146 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 953027052D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370807 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF3241 . This is a "MEDIARE RAILROAD GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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