Provider Demographics
NPI:1275729907
Name:PREMIER FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:PREMIER FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:FOOTE
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-746-9797
Mailing Address - Street 1:7481 RIGHT FLANK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3838
Mailing Address - Country:US
Mailing Address - Phone:804-746-9797
Mailing Address - Fax:804-746-9794
Practice Address - Street 1:7481 RIGHT FLANK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3838
Practice Address - Country:US
Practice Address - Phone:804-746-9797
Practice Address - Fax:804-746-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300807332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0010113580Medicaid
VA5105750001OtherMEDICARE DME
VA0010113580Medicaid