Provider Demographics
NPI:1417952318
Name:PORTLAND FOOT & ANKLE, PA
Entity Type:Organization
Organization Name:PORTLAND FOOT & ANKLE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JURIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-879-1339
Mailing Address - Street 1:68 MARGINAL WAY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-879-1339
Mailing Address - Fax:207-879-1092
Practice Address - Street 1:68 MARGINAL WAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-879-1339
Practice Address - Fax:207-879-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME480030888OtherK. PAUL FLANIGAN
MECH4448OtherPALMETTO GROUP
ME0619920001OtherDMERC GROUP
ME480023694OtherROBERT S. JURIS
MECH4448OtherRAILROAD MEDICARE GROUP
MEMM6230Medicare ID - Type UnspecifiedGROUP ID
ME480023694OtherROBERT S. JURIS
ME480030888OtherK. PAUL FLANIGAN
ME0619920001OtherDMERC GROUP
ME480023694OtherROBERT S. JURIS
ME123460099Medicaid
ME412730099Medicaid
ME480034284OtherDANFORTH DESENA
MEU80571Medicare UPIN
MEMM3116Medicare ID - Type UnspecifiedROBERT S. JURIS, D.P.M.
MEMM8323Medicare ID - Type UnspecifiedK. PAUL FLANIGAN,D.P.M.
ME114830099Medicaid
ME0619920001Medicare NSC