Provider Demographics
NPI:1346214947
Name:FOOT AND ANKLE SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-848-4401
Mailing Address - Street 1:1224 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3923
Mailing Address - Country:US
Mailing Address - Phone:717-848-4401
Mailing Address - Fax:717-718-4043
Practice Address - Street 1:1224 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3923
Practice Address - Country:US
Practice Address - Phone:717-848-4401
Practice Address - Fax:717-718-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17791501261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088887Medicare PIN