Healthcare Provider Details

I. General information

NPI: 1093253700
Provider Name (Legal Business Name): PRIME FOOT AND ANKLE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEETING HOUSE RD STE 5
CHELMSFORD MA
01824-2734
US

IV. Provider business mailing address

817 MERRIMACK ST UNIT 1C
LOWELL MA
01854-3571
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-0657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL GEORGES
Title or Position: PROVIDER
Credential:
Phone: 508-667-8200