Provider Demographics
NPI:1437169075
Name:THE FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:THE FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TALARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-330-8885
Mailing Address - Street 1:1000 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4052
Mailing Address - Country:US
Mailing Address - Phone:912-330-8885
Mailing Address - Fax:912-330-8858
Practice Address - Street 1:1000 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4052
Practice Address - Country:US
Practice Address - Phone:912-330-8885
Practice Address - Fax:912-330-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA945213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA052053396005OtherBLUE CROSS BLUE SHIELD
GADF3241OtherRAILROAD MEDICARE GROUP
GAP00355897OtherMEDICARE RAILROAD PIN
GA5784660001OtherDMERC MEDICARE
GA1831106988OtherINDIVIDUAL NPI
GA10071146Medicaid
GA953027052DMedicaid
GA370807Medicaid
GADF3241OtherMEDIARE RAILROAD GROUP NUMBER
GADF3241OtherRAILROAD MEDICARE GROUP
GAGRP7825Medicare PIN
GA052053396005OtherBLUE CROSS BLUE SHIELD
GA5784660001OtherDMERC MEDICARE
GA=========OtherTIN
GAP00355897Medicare PIN