Healthcare Provider Details

I. General information

NPI: 1669523098
Provider Name (Legal Business Name): ADVANCED FOOT SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VILLAGE PLAZA WAY
N SCITUATE RI
02857-1849
US

IV. Provider business mailing address

19 VILLAGE PLAZA WAY
N SCITUATE RI
02857-1849
US

V. Phone/Fax

Practice location:
  • Phone: 401-934-2600
  • Fax:
Mailing address:
  • Phone: 401-934-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000292
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000292
License Number StateRI

VIII. Authorized Official

Name: DR. JOHN C BOGUE SR.
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 401-934-2600