MEDICARE: RECONSTRUCTIVE FOOT & ANKLE SPECIALISTS, 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	332B00000X	Durable Medical Equipment & Medical Supplies		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285769372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECONSTRUCTIVE FOOT & ANKLE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	7920 W JEFFERSON BLVD
Second Line	:	SUITE 230
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4168
Country	:	US
Telephone Number	:	260-432-7600
Fax Number	:	260-436-8498

Provider Business Practice Location Address
First Line	:	7920 W JEFFERSON BLVD
Second Line	:	SUITE 230
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4168
Country	:	US
Telephone Number	:	260-432-7600
Fax Number	:	260-436-8498

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN NORTON
Credential	:
Telephone Number	:	260-432-7600

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	02/11/2013

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