NPIMap

Organization Active NPI

Cobb Foot & Leg Surgical Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Marietta, GA
National Provider Identifier
1336123264
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
COBB FOOT & LEG SURGICAL CENTER, LLC
Practice address
165 Vann St NE
Marietta, GA 30060-7249
Phone
(770) 422-9856
Fax
(770) 984-0303
NPI assigned
Dec 5, 2005
Last updated
Jan 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Glyn E Lewis, DPM
Title
President
Phone
(770) 422-9856

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X GA Primary

Addresses

Primary practice location

165 Vann St NE
Marietta, GA 30060-7249

Mailing address

165 Vann St NE
Marietta, GA 30060-7249
Phone (770) 422-9856

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060718000050 GA Part B Supplier - Ambulatory Surgical Center 4385657345 Practice locations: Marietta, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Cobb Foot and Leg Surgery Center LLCCCN 11C0001028
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0967852Cobb Foot & Leg Surgery Center165 Vann Street, Marietta, GA 30060Certificate of waiverNov 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cobb Foot and Leg Surgical15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

165 Vann St NE
Marietta, GA 30060
Phone (770) 422-9856

792 Church St NE
Ste 102
Marietta, GA 30060
Phone (678) 574-0861

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1336123264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 VANN ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607249",
            "telephone_number": "770-422-9856",
            "fax_number": "770-984-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 VANN ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607249",
            "telephone_number": "770-422-9856",
            "fax_number": "770-984-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBB FOOT & LEG SURGICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-05",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "GLYN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-422-9856",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.