Provider Demographics
NPI:1255339446
Name:LAKE REGION FAMILY FOOT & ANKLE CENTER
Entity type:Organization
Organization Name:LAKE REGION FAMILY FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-893-1989
Mailing Address - Street 1:211 TANDBERG TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5100
Mailing Address - Country:US
Mailing Address - Phone:207-893-1989
Mailing Address - Fax:207-893-0190
Practice Address - Street 1:211 TANDBERG TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5100
Practice Address - Country:US
Practice Address - Phone:207-893-1989
Practice Address - Fax:207-893-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD221213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME156880000Medicaid
0894600001Medicare NSC
MM6113Medicare ID - Type Unspecified