Provider Demographics
NPI:1003663949
Name:SEACOAST FOOT AND ANKLE CENTER PC
Entity type:Organization
Organization Name:SEACOAST FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-990-7274
Mailing Address - Street 1:28 WILDLIFE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04097-6359
Mailing Address - Country:US
Mailing Address - Phone:215-990-7274
Mailing Address - Fax:
Practice Address - Street 1:51 SEWALL ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2644
Practice Address - Country:US
Practice Address - Phone:207-761-3889
Practice Address - Fax:207-761-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty