Provider Demographics
NPI:1124005699
Name:FOOT SPECIALISTS ASSOCIATES INC
Entity Type:Organization
Organization Name:FOOT SPECIALISTS ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:COURNIOTES
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-783-0114
Mailing Address - Street 1:1786 WILBRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119
Mailing Address - Country:US
Mailing Address - Phone:413-783-0114
Mailing Address - Fax:413-783-3661
Practice Address - Street 1:1786 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119
Practice Address - Country:US
Practice Address - Phone:413-783-0114
Practice Address - Fax:413-783-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1519213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77315OtherBLUE CROSS
GADF5622OtherRAILROAD MEDICARE
MA5096070001Medicare NSC
MAY77315OtherBLUE CROSS
MAY78043Medicare ID - Type Unspecified