Provider Demographics
NPI:1902014491
Name:BIOMECHANICAL PODIATRY PC
Entity Type:Organization
Organization Name:BIOMECHANICAL PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACCOMANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-451-0123
Mailing Address - Street 1:10789 N 90TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6773
Mailing Address - Country:US
Mailing Address - Phone:480-451-0123
Mailing Address - Fax:480-451-4876
Practice Address - Street 1:10789 N 90TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6773
Practice Address - Country:US
Practice Address - Phone:480-451-0123
Practice Address - Fax:480-451-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ338213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ161070481050OtherHUMANA
AZ378615400OtherUS DEPARTMENT OF LABOR
AZ442547OtherMMSI
AZAZ6123OtherHEALTHNET
AZ0005825224OtherAETNA
AZAZ0193360OtherBLUE CROSS BLUE SHIELD ARIZONA
AZ0705963OtherUNITED HEALTHCARE
AZ85260 A001OtherWPS TRICARE
AZAZ6123OtherHEALTHNET