Provider Demographics
NPI:1780856039
Name:FOOT AND ANKLE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-330-2467
Mailing Address - Street 1:1500 N 28TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5332
Mailing Address - Country:US
Mailing Address - Phone:804-330-2467
Mailing Address - Fax:804-330-3366
Practice Address - Street 1:1500 N 28TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5332
Practice Address - Country:US
Practice Address - Phone:804-330-2467
Practice Address - Fax:804-330-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000905213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU44326Medicare UPIN
VA5106090005Medicare NSC