MEDICARE: PRIME FOOT AND ANKLE CARE, LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1093253700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME FOOT AND ANKLE CARE, LLC

Provider Business Mailing Address
First Line	:	817 MERRIMACK ST
Second Line	:	UNIT 1C
City	:	LOWELL
State	:	MA
Zip	:	01854-3571
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEETING HOUSE RD STE 5
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2734
Country	:	US
Telephone Number	:	978-452-0657
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	PAUL GEORGES
Credential	:
Telephone Number	:	508-667-8200

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	12/11/2023

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