Provider Demographics
NPI:1497957161
Name:FAMILY FOOT AND ANKLE CENTER INC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HASH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-339-2446
Mailing Address - Street 1:417 S. LANDMARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5003
Mailing Address - Country:US
Mailing Address - Phone:812-339-2446
Mailing Address - Fax:812-330-9508
Practice Address - Street 1:417 S. LANDMARK AVENUE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5003
Practice Address - Country:US
Practice Address - Phone:812-339-2446
Practice Address - Fax:812-330-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000762A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100184940Medicaid
IN000000089196OtherBLUE CROSS
IN100184940AMedicaid
INP00327018OtherPALMETTO GBA
INP00327018OtherPALMETTO GBA
IN546330Medicare PIN
IN100184940AMedicaid
INU19504Medicare UPIN