Provider Demographics
NPI:1164477527
Name:ANKLE AND FOOT CARE CENTERS
Entity Type:Organization
Organization Name:ANKLE AND FOOT CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-629-8800
Mailing Address - Street 1:3 GREENVILLE ORTHOPEDIC CTR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1210
Mailing Address - Country:US
Mailing Address - Phone:724-588-3770
Mailing Address - Fax:724-588-3774
Practice Address - Street 1:3 GREENVILLE ORTHOPEDIC CTR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1210
Practice Address - Country:US
Practice Address - Phone:724-588-3770
Practice Address - Fax:724-588-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001496124-0005Medicaid
PA001496124-0001Medicaid
OH5504OtherRAILROAD MEDICARE
PA001496124-0004Medicaid
OH0102758Medicaid
OH0996920019Medicare NSC
PA053560Medicare PIN