Provider Demographics
NPI:1417998873
Name:FOOT AND ANKLE CENTER LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-320-3668
Mailing Address - Street 1:1465 JOHNSTON WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-320-3668
Mailing Address - Fax:804-320-2600
Practice Address - Street 1:1465 JOHNSTON WILLIS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-320-3668
Practice Address - Fax:804-320-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417998873Medicaid
VA5466860001Medicare NSC
VA1417998873Medicaid
DC9746Medicare PIN