Provider Demographics
NPI:1578800538
Name:ADULT & CHILD FOOT & ANKLE CARE, LLC
Entity Type:Organization
Organization Name:ADULT & CHILD FOOT & ANKLE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-739-6730
Mailing Address - Street 1:6512 WOODLAKE VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2200
Mailing Address - Country:US
Mailing Address - Phone:804-739-6730
Mailing Address - Fax:804-739-6894
Practice Address - Street 1:2184 PLAINVIEW CTR
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5756
Practice Address - Country:US
Practice Address - Phone:804-403-3000
Practice Address - Fax:804-403-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty