MEDICARE: ADULT & CHILD FOOT & ANKLE CARE, 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	0103300915	VA

General Provider Information

NPI Number	:	1780803528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & CHILD FOOT & ANKLE CARE, LLC

Provider Business Mailing Address
First Line	:	6512 WOODLAKE VILLAGE CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2200
Country	:	US
Telephone Number	:	804-739-6730
Fax Number	:	804-739-6894

Provider Business Practice Location Address
First Line	:	6512 WOODLAKE VILLAGE CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2200
Country	:	US
Telephone Number	:	804-739-6730
Fax Number	:	804-739-6894

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN GERALD MCMAHON JR.
Credential	:	DPM
Telephone Number	:	804-739-6730

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/14/2013

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