Provider Demographics
NPI:1063662575
Name:ANKLE AND FOOT CARE, INC
Entity Type:Organization
Organization Name:ANKLE AND FOOT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-543-3668
Mailing Address - Street 1:186 BLANEY RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-3508
Mailing Address - Country:US
Mailing Address - Phone:724-543-3668
Mailing Address - Fax:724-543-2087
Practice Address - Street 1:186 BLANEY RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-3508
Practice Address - Country:US
Practice Address - Phone:724-543-3668
Practice Address - Fax:724-543-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002620-L213ES0103X
PASC004665-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011858030001Medicaid
PA188543Medicare PIN
PA0011858030001Medicaid
PA0256170002Medicare NSC