Provider Demographics
NPI:1376716910
Name:FOOT & ANKLE HEALTH GROUP PC
Entity Type:Organization
Organization Name:FOOT & ANKLE HEALTH GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-326-3338
Mailing Address - Street 1:933 N CHARLOTTE STREET
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3974
Mailing Address - Country:US
Mailing Address - Phone:610-326-4367
Mailing Address - Fax:610-718-0178
Practice Address - Street 1:6 E PHILADELPHIA AVENUE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1125
Practice Address - Country:US
Practice Address - Phone:610-369-0606
Practice Address - Fax:610-367-0536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT & ANKLE HEALTH GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
423488OtherMEDICARE GROUP