Healthcare Provider Details

I. General information

NPI: 1497957161
Provider Name (Legal Business Name): FAMILY FOOT AND ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S. LANDMARK AVENUE
BLOOMINGTON IN
47403-5003
US

IV. Provider business mailing address

417 S. LANDMARK AVENUE
BLOOMINGTON IN
47403-5003
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-2446
  • Fax: 812-330-9508
Mailing address:
  • Phone: 812-339-2446
  • Fax: 812-330-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000762A
License Number StateIN

VIII. Authorized Official

Name: GERRY L HASH
Title or Position: PRESIDENT
Credential: DPM
Phone: 812-339-2446