Provider Demographics
NPI:1023088846
Name:LITCHFIELD COUNTY FOOT CLINIC & SURGERY CENTER, P.C.
Entity type:Organization
Organization Name:LITCHFIELD COUNTY FOOT CLINIC & SURGERY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CROVO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-489-1661
Mailing Address - Street 1:95 NEW LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6414
Mailing Address - Country:US
Mailing Address - Phone:860-489-1661
Mailing Address - Fax:860-489-5147
Practice Address - Street 1:95 NEW LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6414
Practice Address - Country:US
Practice Address - Phone:860-489-1661
Practice Address - Fax:860-489-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000032213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
030000032CT02OtherANTHEM
CT004006490Medicaid
CT480069612OtherRAILROAD
CT0207740001Medicare NSC
CTC00961Medicare PIN
CT004006490Medicaid