Provider Demographics
NPI:1912079377
Name:CENTER FOR FOOT AND ANKLE CARE PC
Entity Type:Organization
Organization Name:CENTER FOR FOOT AND ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-797-0190
Mailing Address - Street 1:3747 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5309
Mailing Address - Country:US
Mailing Address - Phone:304-797-0190
Mailing Address - Fax:304-797-1187
Practice Address - Street 1:3747 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5309
Practice Address - Country:US
Practice Address - Phone:304-797-0190
Practice Address - Fax:304-797-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006023Medicaid
WVCE9310461Medicare PIN
OH9310463Medicare PIN
PA072794Medicare PIN
WV3810006023Medicaid
WVP00029070Medicare PIN
WV9310462Medicare PIN