Healthcare Provider Details

I. General information

NPI: 1104154863
Provider Name (Legal Business Name): AMERICAN FOOT AND ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 WEST MAIN STREET
PERU IN
46970
US

IV. Provider business mailing address

632 WEST MAIN STREET
PERU IN
46970
US

V. Phone/Fax

Practice location:
  • Phone: 765-473-4220
  • Fax: 765-473-4223
Mailing address:
  • Phone: 765-473-4220
  • Fax: 765-473-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number07000906A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000906A
License Number StateIN

VIII. Authorized Official

Name: DR. BRADLEY R HAMMERSLEY
Title or Position: DOCTOR/OWNER
Credential: D.P.M.
Phone: 765-473-4220