Provider Demographics
NPI:1205055332
Name:ACHILLIES FOOT AND ANKLE CENTER INC
Entity type:Organization
Organization Name:ACHILLIES FOOT AND ANKLE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ULFE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-585-3668
Mailing Address - Street 1:317 B GUTHERIE GREEN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 B GUTHERIE GREEN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-585-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002199Medicaid
DG6310OtherRAILROAD MEDICARE
DG6310OtherRAILROAD MEDICARE
KY1148870001Medicare NSC
KY80002199Medicaid
DG6310OtherRAILROAD MEDICARE