Provider Demographics
NPI:1578509683
Name:ROYALTON FOOT & ANKLE ASSOCIATES PC
Entity Type:Organization
Organization Name:ROYALTON FOOT & ANKLE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-428-2440
Mailing Address - Street 1:4035 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9156
Mailing Address - Country:US
Mailing Address - Phone:269-428-2440
Mailing Address - Fax:269-428-0980
Practice Address - Street 1:4035 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9156
Practice Address - Country:US
Practice Address - Phone:269-428-2440
Practice Address - Fax:269-428-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICO001158213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366587354OtherMEDICARE DME
MI480A16098OtherBCBS
MI0965210001Medicare NSC
MI480A16098OtherBCBS