Provider Demographics
NPI:1043900962
Name:FOOT AND ANKLE CENTERS OF INDIANA LLC
Entity type:Organization
Organization Name:FOOT AND ANKLE CENTERS OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VESTILE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-441-7981
Mailing Address - Street 1:239 ASH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-1752
Mailing Address - Country:US
Mailing Address - Phone:765-485-1814
Mailing Address - Fax:
Practice Address - Street 1:239 ASH ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1752
Practice Address - Country:US
Practice Address - Phone:765-485-1814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty