1497868889 NPI number — AMBULATORY FOOT & ANKLE CENTER, P.C.

Table of content: (NPI 1497868889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497868889 NPI number — AMBULATORY FOOT & ANKLE CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULATORY FOOT & ANKLE CENTER, P.C.
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:
1497868889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1618 HARDY CASH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-825-5783
Provider Business Mailing Address Fax Number:
757-825-9658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1618 HARDY CASH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-825-5783
Provider Business Practice Location Address Fax Number:
757-825-9658
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAWUSI
Authorized Official First Name:
EARNEST
Authorized Official Middle Name:
P.S.
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
757-825-5783

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1477510840 . This is a "NPI FOR DR. KIBWE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009300481 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851474944 . This is a "NPI FOR DR MORGAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1295792562 . This is a "NPI FOR DR. MAWUSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1629019153 . This is a "NPI FOR DR. JOHNSON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010199948 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9300589 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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