MEDICARE: FOOT & ANKLE INNOVATIONS PC

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	SC005851	PA

General Provider Information

NPI Number	:	1396981494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE INNOVATIONS PC

Provider Business Mailing Address
First Line	:	1755 US ROUTE 6 W
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-1025
Country	:	US
Telephone Number	:	814-544-3182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 US ROUTE 6 W
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-1025
Country	:	US
Telephone Number	:	814-544-3182
Fax Number	:	814-544-3184

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL JOSEPH TARBOX
Credential	:	D.P.M.
Telephone Number	:	814-544-3182

Provider Enumeration Date	:	12/21/2008
Last Update Date	:	06/14/2021

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