Ambulatory Foot Care Center P C
Organization Active NPI Podiatrist · Danville, VA
NPI 1801013115 · NPPES record last updated Mar 29, 2013
Key facts
- NPI
- 1801013115
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- 0103 000583 (VA)
- Legal business name
- AMBULATORY FOOT CARE CENTER P C
- Practice address
- 789 Piney Forest Rd
Suite B
Danville, VA 24540-2877 - Phone
- (434) 799-9430
- Fax
- (434) 792-8438
- NPI assigned
- Apr 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Michael T Canavan, DPM
- Title
- Physician Owner
- Phone
- (434) 799-9430
Practitioners 2
-
Michael T Canavan, DPM
-
John Andrew Petery, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100921000119 | VA | Part B Supplier - Clinic/Group Practice | 2668597170 |
Receives reassigned benefits from 1 practitioner Practice locations: Danville, VA |
| O20100930040070 | VA | DME Supplier - Physician - Podiatry | 2668597170 | Practice locations: Danville, VA |
National Provider Directory
Locations
789 Piney Forest Rd
Ste B
Danville, VA 24540
Phone (434) 799-9430
Interoperability endpoints
- https://api.platform.athenahealth.com/3446/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | 0103 000583 | VA | Yes |
Addresses
Primary practice location
789 Piney Forest Rd
Suite B
Danville, VA 24540-2877
Mailing address
789 Piney Forest Rd
Suite B
Danville, VA 24540-2877
Phone (434) 799-9430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891739991 | Other | VA | DR MICHAEL CANAVAN NPI # |
| 009301631 | Medicaid | VA | |
| 46126 | Other | VA | OPTIMA |
| 890803N | Medicaid | NC | |
| 1891739991 | Other | VA | MUTUAL OF OMAHA |
| C02497 | Other | MEDICARE PTAN | |
| CF9579 | Other | VA | RET RAILROAD MCRE |
| 066476 | Other | VA | ANTHEM |
Other providers in Danville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.