MEDICARE: SOUTHAMPTON FOOT & ANKLE CLINIC PC

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	0103001047	VA
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

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

General Provider Information

NPI Number	:	1316978729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHAMPTON FOOT & ANKLE CLINIC PC

Provider Business Mailing Address
First Line	:	P.O. BOX 673
Second Line	:
City	:	FRANKLIN
State	:	VA
Zip	:	23851
Country	:	US
Telephone Number	:	757-562-3002
Fax Number	:	757-562-0333

Provider Business Practice Location Address
First Line	:	110 W SECOND AVE.
Second Line	:
City	:	FRANKLIN
State	:	VA
Zip	:	23851-1712
Country	:	US
Telephone Number	:	757-562-3002
Fax Number	:	757-562-0333

Authorized Official
Title or Position	:	PRES.
Name	:	DR. RODNEY L. BLAND
Credential	:	DPM
Telephone Number	:	757-562-3002

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/24/2009

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