Provider Demographics
NPI:1740227909
Name:FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONATELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:800-292-3008
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:WV
Mailing Address - Zip Code:25909-0365
Mailing Address - Country:US
Mailing Address - Phone:800-292-3008
Mailing Address - Fax:866-420-4578
Practice Address - Street 1:401 ROGERS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3636
Practice Address - Country:US
Practice Address - Phone:800-292-3008
Practice Address - Fax:412-291-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010201641Medicaid
WVDD3197OtherRAILROAD MEDICARE
WV001706519OtherMOUNTAIN STATE BC BS
WV3810007768Medicaid
VAC09555Medicare PIN
WV9353201Medicare PIN
VA010201641Medicaid
WV001706519OtherMOUNTAIN STATE BC BS
WVDD3197OtherRAILROAD MEDICARE