Provider Demographics
NPI:1366250680
Name:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Entity type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-897-2261
Mailing Address - Street 1:PO BOX 825159 DEPARTMENT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 CRESCENT GRN STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8117
Practice Address - Country:US
Practice Address - Phone:301-933-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty