Provider Demographics
NPI:1811032212
Name:CENTER FOR ANKLE & FOOT CARE INC
Entity type:Organization
Organization Name:CENTER FOR ANKLE & FOOT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HENNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-242-2502
Mailing Address - Street 1:3150 CITRUS TOWER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6802
Mailing Address - Country:US
Mailing Address - Phone:352-242-2502
Mailing Address - Fax:352-242-0316
Practice Address - Street 1:3150 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6802
Practice Address - Country:US
Practice Address - Phone:352-242-2502
Practice Address - Fax:352-242-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3047213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA7690OtherRAILROAD MEDICARE
FLAG948Medicare PIN
FL4690780001Medicare NSC