Provider Demographics
NPI:1235477233
Name:PRESTIGE FOOT & ANKLE, PC
Entity type:Organization
Organization Name:PRESTIGE FOOT & ANKLE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-869-7031
Mailing Address - Street 1:277 E CARMEL DR STE D
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2610
Mailing Address - Country:US
Mailing Address - Phone:317-806-8461
Mailing Address - Fax:317-806-8461
Practice Address - Street 1:277 E CARMEL DR STE D
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2610
Practice Address - Country:US
Practice Address - Phone:317-846-4111
Practice Address - Fax:317-846-1767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE FOOT & ANKLE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000947A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDP9942OtherPALMETTO GBA
INDP9942OtherPALMETTO GBA