Provider Demographics
NPI:1861670770
Name:ACHILLES FOOT HEALTH CENTER, L.L.C.
Entity Type:Organization
Organization Name:ACHILLES FOOT HEALTH CENTER, L.L.C.
Other - Org Name:ADVANCED FOOTCARE SPECIALISTS OF CONNECTICUT L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUROCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-239-1119
Mailing Address - Street 1:20 WASHINGTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2343
Mailing Address - Country:US
Mailing Address - Phone:203-239-1119
Mailing Address - Fax:203-234-1832
Practice Address - Street 1:20 WASHINGTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2343
Practice Address - Country:US
Practice Address - Phone:203-239-1119
Practice Address - Fax:203-234-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00709213ES0131X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2704187OtherUNTIED HEALTHCARE
CT004191277Medicaid
CT103244500OtherFEDERAL DOL OWCP
CTCPD# 1392050OtherAETNA - COVENTRY-FIRST HEALTH
CT007090OtherCONNECTICARE
CT11066538OtherMULTIPLAN
CT008003227Medicaid
CTDO3120OtherMEDICARE RAILROAD
CT030000709CT01OtherANTHEM
CT2110284OtherAETNA
CTP1271789OtherOXFORD
CT60353065001OtherCIGNA
CT008003227Medicaid
CT1296940001Medicare NSC
CTC01740Medicare PIN