Provider Demographics
NPI:1740749928
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:JOHN
Authorized Official - Last Name:DONATELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-228-8888
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:304-487-9442
Mailing Address - Fax:
Practice Address - Street 1:3690 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9653
Practice Address - Country:US
Practice Address - Phone:304-487-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV363Medicaid