Provider Demographics
NPI:1154794097
Name:VALLEY FOOT AND ANKLE CARE PLLC
Entity type:Organization
Organization Name:VALLEY FOOT AND ANKLE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLSION
Authorized Official - Middle Name:S
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-797-0190
Mailing Address - Street 1:362 AMERICAN WAY
Mailing Address - Street 2:SUITE1
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4083
Mailing Address - Country:US
Mailing Address - Phone:304-797-0190
Mailing Address - Fax:304-797-1187
Practice Address - Street 1:362 AMERICAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4083
Practice Address - Country:US
Practice Address - Phone:304-797-0190
Practice Address - Fax:304-797-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-31
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7580180001Medicare NSC