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General NPI Number Information
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NPI Number | 1164751418
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Entity Type | Organization
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Legal Business Name | ACHILLES FOOT & ANKLE SURGERY PC
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 46898 NATIONAL RD W
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City | ST. CLAIRSVILLE
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State | OH
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Zip | 43950
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Country | US
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Telephone | 740-695-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 46898 NATIONAL RD W
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City | ST. CLAIRSVILLE
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State | OH
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Zip | 43950
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Country | US
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Telephone | 740-695-4188
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE G BLANK
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Credential | DPM
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Telephone | 740-695-4188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36-00-2569-B
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License Number State | OH
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