Provider Demographics
NPI:1497868889
Name:AMBULATORY FOOT & ANKLE CENTER, P.C.
Entity Type:Organization
Organization Name:AMBULATORY FOOT & ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARNEST
Authorized Official - Middle Name:PS
Authorized Official - Last Name:MAWUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-825-5783
Mailing Address - Street 1:1618 HARDY CASH DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2400
Mailing Address - Country:US
Mailing Address - Phone:757-825-5783
Mailing Address - Fax:757-825-9658
Practice Address - Street 1:1618 HARDY CASH DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2400
Practice Address - Country:US
Practice Address - Phone:757-825-5783
Practice Address - Fax:757-825-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477510840OtherNPI FOR DR. KIBWE
VA009300481Medicaid
VA1851474944OtherNPI FOR DR MORGAN
VA1295792562OtherNPI FOR DR. MAWUSI
VA1629019153OtherNPI FOR DR. JOHNSON
VA010199948Medicaid
VA9300589Medicaid
VA9300589Medicaid
VA480000426Medicare PIN
VAV05330Medicare UPIN
VAU50018Medicare UPIN
VA009300481Medicaid
VA1477510840OtherNPI FOR DR. KIBWE
VAU50558Medicare UPIN