Provider Demographics
NPI:1215138268
Name:RECONSTRUCTIVE FOOT & ANKLE SPECIALISTS, LLC
Entity type:Organization
Organization Name:RECONSTRUCTIVE FOOT & ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:260-432-7600
Mailing Address - Street 1:7910 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-432-7600
Mailing Address - Fax:
Practice Address - Street 1:1316 E 7TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2523
Practice Address - Country:US
Practice Address - Phone:260-432-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200847960Medicaid
IN5887650002Medicare NSC
IN200847960Medicaid
IN251000Medicare PIN