Provider Demographics
NPI:1881746642
Name:LYNNHAVEN FOOT AND ANKLE CENTER, INC.
Entity type:Organization
Organization Name:LYNNHAVEN FOOT AND ANKLE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VUOLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-963-6363
Mailing Address - Street 1:1547 AMBERLEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-4706
Mailing Address - Country:US
Mailing Address - Phone:757-963-6363
Mailing Address - Fax:757-363-3453
Practice Address - Street 1:1547 AMBERLEY FOREST RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4706
Practice Address - Country:US
Practice Address - Phone:757-963-6363
Practice Address - Fax:757-363-3453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300951332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1026024Medicaid
VA5936440001OtherMEDICARE DMEPOS
VA5936440001Medicare NSC
VA5936440001OtherMEDICARE DMEPOS
VAC10205Medicare PIN