Provider Demographics
NPI:1285713370
Name:MAYSVILLE FOOT & ANKLE CLINIC
Entity type:Organization
Organization Name:MAYSVILLE FOOT & ANKLE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAWSAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:606-759-5686
Mailing Address - Street 1:2011 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056
Mailing Address - Country:US
Mailing Address - Phone:606-759-5686
Mailing Address - Fax:606-759-0368
Practice Address - Street 1:2011 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056
Practice Address - Country:US
Practice Address - Phone:606-759-5686
Practice Address - Fax:606-759-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00213213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90110818Medicaid
KY4197320001Medicare NSC
2012101Medicare PIN
KY90110818Medicaid
KYP100040505Medicare PIN