MEDICARE: FOOT AND ANKLE CENTER OF PHILADELPHIA, 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

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	:	1639258916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE CENTER OF PHILADELPHIA, LLC

Provider Business Mailing Address
First Line	:	12401 ACADEMY RD STE 201
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1934
Country	:	US
Telephone Number	:	215-637-3121
Fax Number	:	215-437-7738

Provider Business Practice Location Address
First Line	:	12401 ACADEMY RD STE 201
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1934
Country	:	US
Telephone Number	:	215-637-3121
Fax Number	:	215-437-7738

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN F BOC
Credential	:	DPM
Telephone Number	:	215-637-3121

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	03/09/2026

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Directions to “FOOT AND ANKLE CENTER OF PHILADELPHIA, LLC ” Practice Location

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