Provider Demographics
NPI:1588980114
Name:CENTER FOR FOOT & ANKLE EXCELLENCE
Entity type:Organization
Organization Name:CENTER FOR FOOT & ANKLE EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-483-2006
Mailing Address - Street 1:5735 RIDGE AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1745
Mailing Address - Country:US
Mailing Address - Phone:215-483-2006
Mailing Address - Fax:215-483-2066
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:STE 208
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1745
Practice Address - Country:US
Practice Address - Phone:215-483-2006
Practice Address - Fax:215-483-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004111L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024531700001Medicaid
PA1024531700001Medicaid
PA6684370001Medicare NSC