Healthcare Provider Details

I. General information

NPI: 1285769372
Provider Name (Legal Business Name): RECONSTRUCTIVE FOOT & ANKLE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 W JEFFERSON BLVD SUITE 230
FORT WAYNE IN
46804-4168
US

IV. Provider business mailing address

7920 W JEFFERSON BLVD SUITE 230
FORT WAYNE IN
46804-4168
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-7600
  • Fax: 260-436-8498
Mailing address:
  • Phone: 260-432-7600
  • Fax: 260-436-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIN

VIII. Authorized Official

Name: JONATHAN NORTON
Title or Position: PRESIDENT
Credential:
Phone: 260-432-7600