Provider Demographics
NPI:1639258916
Name:FOOT AND ANKLE CENTER OF PHILADELPHIA, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF PHILADELPHIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-568-3510
Mailing Address - Street 1:235 N BROAD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1511
Mailing Address - Country:US
Mailing Address - Phone:215-568-3510
Mailing Address - Fax:215-568-3529
Practice Address - Street 1:235 N BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-568-3510
Practice Address - Fax:215-568-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0978058Medicaid
T29711Medicare UPIN
PA0978058Medicaid
PA153969Medicare ID - Type Unspecified
PA110906Medicare PIN