Provider Demographics
NPI:1316978729
Name:SOUTHAMPTON FOOT & ANKLE CLINIC PC
Entity type:Organization
Organization Name:SOUTHAMPTON FOOT & ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-562-3002
Mailing Address - Street 1:P.O. BOX 673
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851
Mailing Address - Country:US
Mailing Address - Phone:757-562-3002
Mailing Address - Fax:757-562-0333
Practice Address - Street 1:110 W SECOND AVE.
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1712
Practice Address - Country:US
Practice Address - Phone:757-562-3002
Practice Address - Fax:757-562-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001047213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009300007Medicaid
VA3904980001Medicare NSC
VA009300007Medicaid
VAC06772Medicare PIN