Provider Demographics
NPI:1194091629
Name:FOOT & ANKLE ASSOCIATES OF CENTRAL IL LLC
Entity type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES OF CENTRAL IL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-243-1101
Mailing Address - Street 1:1515 W WALNUT ST STE 12
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1158
Mailing Address - Country:US
Mailing Address - Phone:217-243-1101
Mailing Address - Fax:217-243-5003
Practice Address - Street 1:1603 WEST WASHINGTON
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4794
Practice Address - Country:US
Practice Address - Phone:217-744-7529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty