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General NPI Number Information
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NPI Number | 1033233739
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE ASSOCIATES OF CENTRAL ILLINOIS LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 100 W 15TH ST
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City | BEARDSTOWN
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State | IL
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Zip | 62618-1774
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Country | US
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Telephone | 217-323-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 W WALNUT ST STE 12
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1158
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Country | US
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Telephone | 217-243-1101
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Fax | 217-243-5003
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN FLEISCHLI
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Credential | DPM
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Telephone | 217-243-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 016004737
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License Number State | IL
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