Provider Demographics
NPI:1710159215
Name:FOOT AND ANKLE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-273-1717
Mailing Address - Street 1:3805 CUTSHAW AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3943
Mailing Address - Country:US
Mailing Address - Phone:804-359-7412
Mailing Address - Fax:804-359-7418
Practice Address - Street 1:7660 E PARHAM RD
Practice Address - Street 2:MOB1, SUITE 104A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4378
Practice Address - Country:US
Practice Address - Phone:804-273-1717
Practice Address - Fax:804-273-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000739213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21503Medicare UPIN
VA5106090001Medicare NSC