Provider Demographics
NPI:1235477233
Name:PRESTIGE FOOT & ANKLE, PC
Entity Type:Organization
Organization Name:PRESTIGE FOOT & ANKLE, PC
Other - Org Name:PRESTIGE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-931-0664
Mailing Address - Street 1:6299 GUION RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2530
Mailing Address - Country:US
Mailing Address - Phone:317-931-0664
Mailing Address - Fax:888-510-7211
Practice Address - Street 1:5128 E STOP 11 RD
Practice Address - Street 2:SUITE 40
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6338
Practice Address - Country:US
Practice Address - Phone:317-881-0070
Practice Address - Fax:317-885-0856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE FOOT & ANKLE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000947A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDP9942OtherPALMETTO GBA
INDP9942OtherPALMETTO GBA