Provider Demographics
NPI:1588835805
Name:FOOT AND ANKLE PAIN CENTER
Entity Type:Organization
Organization Name:FOOT AND ANKLE PAIN CENTER
Other - Org Name:EVELEIGH WILLIAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELEIGH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-957-3668
Mailing Address - Street 1:17500 E CARRIAGEWAY DR
Mailing Address - Street 2:STE A
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2057
Mailing Address - Country:US
Mailing Address - Phone:708-957-3668
Mailing Address - Fax:708-957-4555
Practice Address - Street 1:17500 E CARRIAGEWAY DR
Practice Address - Street 2:STE A
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2057
Practice Address - Country:US
Practice Address - Phone:708-957-3668
Practice Address - Fax:708-957-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4236470001Medicare NSC
ILU54512Medicare UPIN