Provider Demographics
NPI:1467786228
Name:ADVANCED CENTER FOR FOOT & ANKLE
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-345-2488
Mailing Address - Street 1:2487 S GILBERT RD 106-606
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8899
Mailing Address - Country:US
Mailing Address - Phone:480-664-7490
Mailing Address - Fax:
Practice Address - Street 1:2815 S ALMA SCHOOL RD STE 119B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4031
Practice Address - Country:US
Practice Address - Phone:480-664-7490
Practice Address - Fax:480-664-7512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONES FAMILY MEDICINE & PAIN CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-28
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0676213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394459Medicaid
AZZ133406Medicare PIN
AZ6373630001Medicare NSC