MEDICARE: CENTER GROVE FOOT & ANKLE CARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP1100X	Podiatric Clinic/Center	07000797	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480033210	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073793816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER GROVE FOOT & ANKLE CARE, P.C.

Provider Business Mailing Address
First Line	:	7855 S EMERSON AVE STE T
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8669
Country	:	US
Telephone Number	:	317-859-2905
Fax Number	:

Provider Business Practice Location Address
First Line	:	7855 S EMERSON AVE STE T
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8669
Country	:	US
Telephone Number	:	317-859-2905
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK H. RUNKLE
Credential	:	D.P.M.
Telephone Number	:	317-859-2905

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	02/26/2025

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Directions to “CENTER GROVE FOOT & ANKLE CARE, P.C. ” Practice Location

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