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General NPI Number Information
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NPI Number | 1801013115
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Entity Type | Organization
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Legal Business Name | AMBULATORY FOOT CARE CENTER P C
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 789 PINEY FOREST RD SUITE B
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City | DANVILLE
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State | VA
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Zip | 24540-2877
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Country | US
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Telephone | 434-799-9430
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Fax | 434-792-8438
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Provider Business Mailing Address
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Address Line | 789 PINEY FOREST RD SUITE B
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City | DANVILLE
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State | VA
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Zip | 24540-2877
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Country | US
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Telephone | 434-799-9430
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Fax | 434-792-8438
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | MICHAEL T CANAVAN
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Credential | DPM
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Telephone | 434-799-9430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103 000583
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License Number State | VA
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