Provider Demographics
NPI:1780776567
Name:ADVANCED FOOT & ANKLE PLLC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-459-8127
Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:STE 153
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218
Mailing Address - Country:US
Mailing Address - Phone:502-459-8127
Mailing Address - Fax:502-459-8620
Practice Address - Street 1:3430 NEWBURG RD
Practice Address - Street 2:STE 153
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-459-8127
Practice Address - Fax:502-459-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0976701Medicare ID - Type Unspecified
0976702Medicare ID - Type Unspecified
U77339Medicare UPIN
T69324Medicare UPIN
KY5261070001Medicare NSC