Provider Demographics
NPI:1003294539
Name:ADVANCED ANKLE AND FOOT CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED ANKLE AND FOOT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-864-9560
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-6554
Mailing Address - Country:US
Mailing Address - Phone:614-864-9560
Mailing Address - Fax:614-864-9709
Practice Address - Street 1:1930 CROWN PARK CT
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2402
Practice Address - Country:US
Practice Address - Phone:614-457-3212
Practice Address - Fax:614-457-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty