Provider Demographics
NPI:1053400176
Name:FOOT HEALTH CENTER, LLC
Entity type:Organization
Organization Name:FOOT HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-271-0556
Mailing Address - Street 1:714 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3448
Mailing Address - Country:US
Mailing Address - Phone:203-271-0556
Mailing Address - Fax:203-250-9951
Practice Address - Street 1:714 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3448
Practice Address - Country:US
Practice Address - Phone:203-271-0556
Practice Address - Fax:203-250-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT395213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT787023OtherCONNECTICARE
CT129286OtherFIRST CHOICE PREF ONE
CT4068714Medicaid
CT030000395CT01OtherANTHEM BCBS
CT2721297OtherAETNA
CT0542290OtherCIGNA
CT129286OtherWELLCARE
CT2V1300OtherHEALTHNET
CT480028957OtherMEDICARE RAILROAD
CTNHS221OtherOXFORD HEALTH PLAN
CT4475020001Medicare NSC
CT030000395CT01OtherANTHEM BCBS
CT2721297OtherAETNA