Provider Demographics
NPI:1144204736
Name:CENTERS FOR FOOT & ANKLE CARE LLC
Entity Type:Organization
Organization Name:CENTERS FOR FOOT & ANKLE CARE LLC
Other - Org Name:CENTERS FOR FOOT AND ANKLE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FRASCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-725-3444
Mailing Address - Street 1:32743 23 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2176
Mailing Address - Country:US
Mailing Address - Phone:586-725-3444
Mailing Address - Fax:586-725-0984
Practice Address - Street 1:1151 STONE DR STE 10J
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1664
Practice Address - Country:US
Practice Address - Phone:513-662-3900
Practice Address - Fax:513-662-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2128674Medicaid
OH9294772Medicare PIN
CN5629Medicare PIN
0698420014Medicare NSC