Provider Demographics
NPI:1922036326
Name:ADVANCED FOOT & ANKLE PC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-243-3630
Mailing Address - Street 1:1115 FAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-2303
Mailing Address - Country:US
Mailing Address - Phone:724-243-3630
Mailing Address - Fax:724-243-3680
Practice Address - Street 1:1115 FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-2303
Practice Address - Country:US
Practice Address - Phone:724-243-3630
Practice Address - Fax:724-243-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067568Medicare PIN