Provider Demographics
NPI:1275541476
Name:AFFILIATED FOOT CARE, PC
Entity Type:Organization
Organization Name:AFFILIATED FOOT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-747-3567
Mailing Address - Street 1:116 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2663
Mailing Address - Country:US
Mailing Address - Phone:508-747-3567
Mailing Address - Fax:508-830-1224
Practice Address - Street 1:116 LONG POND RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2663
Practice Address - Country:US
Practice Address - Phone:508-747-3567
Practice Address - Fax:508-830-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1747213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77173OtherBLUE CROSS GROUP ID
MA0041755002OtherCIGNA
MAY77173OtherBLUE CROSS BLUE SHIELD
MA33076OtherHARVARD PILGRIM
MA4386173OtherAETNA
MA605178OtherTUFTS INSURANCE GROUP ID
MAY77173OtherBLUE CROSS BLUE SHIELD
MAY77173OtherBLUE CROSS GROUP ID
MA33076OtherHARVARD PILGRIM