Provider Demographics
NPI:1538504345
Name:FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-897-2261
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:WV
Mailing Address - Zip Code:25909-0365
Mailing Address - Country:US
Mailing Address - Phone:304-487-9442
Mailing Address - Fax:866-420-4578
Practice Address - Street 1:833 COOK PARKWAY
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870
Practice Address - Country:US
Practice Address - Phone:304-487-9442
Practice Address - Fax:866-420-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00363213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty