Provider Demographics
NPI:1396820486
Name:PODIATRY GROUP, LLC
Entity Type:Organization
Organization Name:PODIATRY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:434-979-0763
Mailing Address - Street 1:600 PETER JEFFERSON PARKWAY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911
Mailing Address - Country:US
Mailing Address - Phone:434-979-0763
Mailing Address - Fax:434-979-8681
Practice Address - Street 1:600 PETER JEFFERSON PARKWAY
Practice Address - Street 2:SUITE 360
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911
Practice Address - Country:US
Practice Address - Phone:434-979-0763
Practice Address - Fax:434-979-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACG1858OtherMEDICARE RAILROAD
VA1306060001Medicare NSC