Provider Demographics
NPI:1831372812
Name:AFFILIATED FOOT CARE CLINIC PC
Entity type:Organization
Organization Name:AFFILIATED FOOT CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-944-5600
Mailing Address - Street 1:5120 CHARLESTOWN RD
Mailing Address - Street 2:STE 6
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9497
Mailing Address - Country:US
Mailing Address - Phone:812-944-5600
Mailing Address - Fax:812-944-4674
Practice Address - Street 1:5120 CHARLESTOWN RD
Practice Address - Street 2:STE 6
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9497
Practice Address - Country:US
Practice Address - Phone:812-944-5600
Practice Address - Fax:812-944-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200265250AMedicaid
U67892Medicare UPIN
IN200265250AMedicaid
Y78041Medicare PIN
IN5103710001Medicare NSC