Provider Demographics
NPI:1073781076
Name:JAMES RIVER FOOT & ANKLE CENTER P C
Entity Type:Organization
Organization Name:JAMES RIVER FOOT & ANKLE CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WAX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-530-0300
Mailing Address - Street 1:13125 RIVERS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2699
Mailing Address - Country:US
Mailing Address - Phone:804-530-0300
Mailing Address - Fax:
Practice Address - Street 1:13125 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2699
Practice Address - Country:US
Practice Address - Phone:804-530-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000780213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4244940001Medicare NSC