=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841220530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT AND ANKLE ASSOCIATES OF SOUTHWEST VIRGINIA, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1802 BRAEBURN DR STE M120
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24153-7357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-344-3668
-----------------------------------------------------
Fax | 540-769-6381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 WALNUT AVE SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24016-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-344-3668
-----------------------------------------------------
Fax | 540-769-6381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO PRESIDENT
-----------------------------------------------------
Name | DR. CHARLES M ZELEN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 540-344-3668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 0103001015
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------