Provider Demographics
NPI:1528380318
Name:ARLINGTON MANSFIELD FOOT & ANKLE CENTERS, PA
Entity Type:Organization
Organization Name:ARLINGTON MANSFIELD FOOT & ANKLE CENTERS, PA
Other - Org Name:ARLINGTON FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-467-1990
Mailing Address - Street 1:400 W ARBROOK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3174
Mailing Address - Country:US
Mailing Address - Phone:817-467-1990
Mailing Address - Fax:817-466-8737
Practice Address - Street 1:400 W ARBROOK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-467-1990
Practice Address - Fax:817-466-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7691060001OtherDMERC NSC