Provider Demographics
NPI:1740591726
Name:ADVANCED PODIATRY, INC.
Entity Type:Organization
Organization Name:ADVANCED PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:563-242-3434
Mailing Address - Street 1:1320 11TH ST NW STE F
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5069
Mailing Address - Country:US
Mailing Address - Phone:563-242-3434
Mailing Address - Fax:563-242-3439
Practice Address - Street 1:1320 11TH ST NW STE F
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5069
Practice Address - Country:US
Practice Address - Phone:563-242-3434
Practice Address - Fax:563-242-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00695213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12424OtherBLUE CROSS BLUE SHIELD
IA0001378Medicaid
IA12424OtherBLUE CROSS BLUE SHIELD
IA6402850001Medicare NSC