Provider Demographics
NPI:1104154863
Name:AMERICAN FOOT AND ANKLE INC
Entity type:Organization
Organization Name:AMERICAN FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMMERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-473-4220
Mailing Address - Street 1:632 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970
Mailing Address - Country:US
Mailing Address - Phone:765-473-4220
Mailing Address - Fax:765-473-4223
Practice Address - Street 1:632 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970
Practice Address - Country:US
Practice Address - Phone:765-473-4220
Practice Address - Fax:765-473-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000906A332B00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7977917OtherCIGNA
IN000000670197OtherBLUE CROSS BLUE SHIELD
IN200984730Medicaid
IN6249610001Medicare NSC
IN000000670197OtherBLUE CROSS BLUE SHIELD