Provider Demographics
NPI:1245241819
Name:FOOT & ANKLE ASSOCIATES
Entity Type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:606-889-0095
Mailing Address - Street 1:5230 KY RT 321
Mailing Address - Street 2:STE 1
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-889-0095
Mailing Address - Fax:606-889-0080
Practice Address - Street 1:5230 KY RT 321
Practice Address - Street 2:STE 1
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-889-0095
Practice Address - Fax:606-889-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X, 213ES0103X
KY00186332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80930878Medicaid
05389Medicare ID - Type Unspecified