Provider Demographics
NPI:1275788499
Name:CROSSROADS FOOT AND ANKLE PODIATRY PC
Entity Type:Organization
Organization Name:CROSSROADS FOOT AND ANKLE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:574-223-6050
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-0548
Mailing Address - Country:US
Mailing Address - Phone:574-223-6050
Mailing Address - Fax:574-223-3057
Practice Address - Street 1:120 E 18TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-2632
Practice Address - Country:US
Practice Address - Phone:574-223-6050
Practice Address - Fax:574-223-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0311390001OtherDME
IN000000091947OtherBCBS
IN100173510AMedicaid
INM100060875OtherMEDICARE PTAN
IN000000091947OtherBCBS
T34901Medicare UPIN