Provider Demographics
NPI:1255085072
Name:ADVANCED CARE FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:ADVANCED CARE FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-814-7029
Mailing Address - Street 1:930 FOLLY RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3938
Mailing Address - Country:US
Mailing Address - Phone:843-606-0019
Mailing Address - Fax:843-604-0566
Practice Address - Street 1:930 FOLLY RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3938
Practice Address - Country:US
Practice Address - Phone:843-606-0019
Practice Address - Fax:843-604-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty