Provider Demographics
NPI:1013008572
Name:ADVANCED FOOT & ANKLE CARE, PLLC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-776-7990
Mailing Address - Street 1:400 PRESTIGE PARK DR STE 400B1
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8420
Mailing Address - Country:US
Mailing Address - Phone:304-776-7990
Mailing Address - Fax:304-776-7974
Practice Address - Street 1:400 PRESTIGE PARK DR STE 400B1
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8420
Practice Address - Country:US
Practice Address - Phone:304-776-7990
Practice Address - Fax:304-776-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV00354213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013008572OtherNPI
WV4792680001OtherDMERC
1013008572OtherNPI
WV4792680001OtherDMERC