Basic Information
| Provider Information | |||||||||
| NPI: | 1194959676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED FOOT AND ANKLE CLINIC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1029 MEDICAL CENTER CIR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420661189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702514545 | ||||||||
| FaxNumber: | 2702514546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1029 MEDICAL CENTER CIR | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420661189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702514060 | ||||||||
| FaxNumber: | 2702514064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2702514060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 00328 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.