Provider Demographics
NPI:1205816766
Name:FOOT AND ANKLE SURGICAL ASSOC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-1544
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:FOOT AND ANKLE SURGICAL ASSOC
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0810
Mailing Address - Country:US
Mailing Address - Phone:207-854-1544
Mailing Address - Fax:207-854-1516
Practice Address - Street 1:952 POST ROAD
Practice Address - Street 2:FOOT AND ANKLE SURGICAL ASSOC
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090
Practice Address - Country:US
Practice Address - Phone:207-646-9996
Practice Address - Fax:207-646-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1039213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1659479541OtherIND NPI #
ME022848OtherANTHEM MAINE
ME1205816766OtherGROUP NPI #
ME431952200Medicaid
MEMM9150OtherMEDICARE IND PIN
ME431952200Medicaid
ME5444780001Medicare NSC
MEU87607Medicare UPIN