MEDICARE: ADVANCED ANKLE AND FOOT CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1003294539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ANKLE AND FOOT CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1554
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-6554
Country	:	US
Telephone Number	:	614-864-9560
Fax Number	:	614-864-9709

Provider Business Practice Location Address
First Line	:	1930 CROWN PARK CT
Second Line	:	SUITE 120
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2402
Country	:	US
Telephone Number	:	614-457-3212
Fax Number	:	614-457-4052

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	JENNIFER JONES
Credential	:
Telephone Number	:	614-864-9560

Provider Enumeration Date	:	05/17/2015
Last Update Date	:	05/17/2015

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