Provider Demographics
NPI:1164977021
Name:FOOT AND ANKLE SPECIALISTS OF CENTRAL PA, P.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF CENTRAL PA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-515-2625
Mailing Address - Street 1:4 FLOWERS DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 FLOWERS DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1701
Practice Address - Country:US
Practice Address - Phone:215-205-6973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031386180001Medicaid
PA538452Medicare PIN