Provider Demographics
NPI:1881844488
Name:WARSAW FOOT AND ANKLE CENTER PC
Entity Type:Organization
Organization Name:WARSAW FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:574-269-9200
Mailing Address - Street 1:2280 PROVIDENT CT STE B
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3284
Mailing Address - Country:US
Mailing Address - Phone:574-269-9200
Mailing Address - Fax:574-269-9658
Practice Address - Street 1:2280 PROVIDENT CT STE B
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3284
Practice Address - Country:US
Practice Address - Phone:574-269-9200
Practice Address - Fax:574-269-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000846213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200158810BMedicaid
151750Medicare PIN
IN200158810BMedicaid
4247340001Medicare NSC