Provider Demographics
NPI:1285665687
Name:PHILADELPHIA FOOT AND ANKLE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PHILADELPHIA FOOT AND ANKLE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:AMETTE
Authorized Official - Last Name:MCCANTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-465-5342
Mailing Address - Street 1:1217 SNYDER AVE # 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-5512
Mailing Address - Country:US
Mailing Address - Phone:215-465-5342
Mailing Address - Fax:
Practice Address - Street 1:5656 CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1742
Practice Address - Country:US
Practice Address - Phone:215-465-5342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2352669000OtherAMERIHEALTH
PA01968145Medicaid
PA30020474OtherKEYSTONE MERCY
PAU96359Medicare UPIN
PA01968145Medicaid
PA5665440002Medicare NSC