Provider Demographics
NPI:1417183534
Name:SPRINGFIELD FOOT & ANKLE CENTER, LTD.
Entity Type:Organization
Organization Name:SPRINGFIELD FOOT & ANKLE CENTER, LTD.
Other - Org Name:ALLIED PODIATRY GROUP LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:LIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-569-2444
Mailing Address - Street 1:6116 ROLLING RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1521
Mailing Address - Country:US
Mailing Address - Phone:703-569-2444
Mailing Address - Fax:703-569-5667
Practice Address - Street 1:6116 ROLLING RD
Practice Address - Street 2:SUITE 116
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1521
Practice Address - Country:US
Practice Address - Phone:703-569-2444
Practice Address - Fax:703-569-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000282261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9300767Medicaid
VA9300767Medicaid
0870460001Medicare NSC
108939Medicare PIN