Provider Demographics
NPI:1720023237
Name:INSTITUTE FOR CORRECTIVE SURGERY OF THE FOOT & ANKLE, INC.
Entity Type:Organization
Organization Name:INSTITUTE FOR CORRECTIVE SURGERY OF THE FOOT & ANKLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-283-6471
Mailing Address - Street 1:501 W ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5337
Mailing Address - Country:US
Mailing Address - Phone:912-283-7596
Mailing Address - Fax:912-283-1618
Practice Address - Street 1:2003 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6209
Practice Address - Country:US
Practice Address - Phone:912-283-7596
Practice Address - Fax:912-283-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA148-201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA490004800OtherRAILROAD MEDICARE
GA148-201OtherGA STATE PERMIT
GA000894605AMedicaid
GA490004800OtherRAILROAD MEDICARE