Provider Demographics
NPI:1770636045
Name:SAN FRANCISCO FOOT AND ANKLE CENTER, A PODIATRY GROUP INC
Entity Type:Organization
Organization Name:SAN FRANCISCO FOOT AND ANKLE CENTER, A PODIATRY GROUP INC
Other - Org Name:NOVATO FOOT AND ANKLE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-898-9818
Mailing Address - Street 1:165 ROWLAND WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5038
Mailing Address - Country:US
Mailing Address - Phone:415-898-9818
Mailing Address - Fax:415-892-3475
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5038
Practice Address - Country:US
Practice Address - Phone:415-898-9818
Practice Address - Fax:415-892-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0630070001Medicare NSC
CAZZZ96694ZMedicare PIN
CADA2213Medicare PIN