Provider Demographics
NPI:1841657954
Name:ADVANCED FOOT & ANKLE ASSOCIATES, INC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:309-762-5200
Mailing Address - Street 1:840 35TH AVENUE PL
Mailing Address - Street 2:STE 102
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8026
Mailing Address - Country:US
Mailing Address - Phone:309-762-5200
Mailing Address - Fax:309-762-5636
Practice Address - Street 1:840 35TH AVENUE PL
Practice Address - Street 2:STE 102
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8026
Practice Address - Country:US
Practice Address - Phone:309-762-5200
Practice Address - Fax:309-762-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7491830001Medicare NSC