MEDICARE: FOOT AND ANKLE SURGICAL CENTER 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	261QP1100X	Podiatric Clinic/Center	17791501	PA

General Provider Information

NPI Number	:	1346214947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	1224 S QUEEN ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-3923
Country	:	US
Telephone Number	:	717-848-4401
Fax Number	:	717-718-4043

Provider Business Practice Location Address
First Line	:	1224 S QUEEN ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-3923
Country	:	US
Telephone Number	:	717-848-4401
Fax Number	:	717-718-4043

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. R. CRAIG MARTIN
Credential	:	D.P.M.
Telephone Number	:	717-848-4401

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	11/15/2007

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