Provider Demographics
NPI:1982817912
Name:ACHILLES HEEL LLC
Entity Type:Organization
Organization Name:ACHILLES HEEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-933-4645
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:STE A-3
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-933-4645
Mailing Address - Fax:623-977-4482
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:STE A-3
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-933-4645
Practice Address - Fax:623-977-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0407213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539452Medicaid
6023360001Medicare NSC
AZZ108166Medicare PIN
AZ539452Medicaid
AZT29494Medicare UPIN
611701400OtherDEPT OF LABOR
AZAZ0195830OtherBLUE CROSS BLUE SHIELD