Provider Demographics
NPI:1841220530
Name:FOOT AND ANKLE ASSOCIATES OF SOUTHWEST VIRGINIA, P.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE ASSOCIATES OF SOUTHWEST VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZELEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:540-344-3668
Mailing Address - Street 1:222 WALNUT AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4723
Mailing Address - Country:US
Mailing Address - Phone:540-344-3668
Mailing Address - Fax:540-769-6381
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:STE M120
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-344-3668
Practice Address - Fax:540-769-6381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001015213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5715980001Medicare NSC
VAC09835Medicare PIN
VADE8929Medicare PIN