| On the Move Podiatry LLC | |
|
19636 N 27th Ave Ste 207 Phoenix AZ 85027-4015 | |
| (602) 993-2700 | |
| Not Available |
| Full Name | On the Move Podiatry LLC |
|---|---|
| Speciality | Podiatrist |
| Location | 19636 N 27th Ave Ste 207, Phoenix, Arizona |
| Authorized Official Name and Position | Shelly Ferrulli (OFFICE MANAGER) |
| Authorized Official Contact | 6029932700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| On the Move Podiatry LLC 19636 N 27th Ave Ste 301 Phoenix AZ 85027-4016 Ph: (602) 993-2700 | On the Move Podiatry LLC 19636 N 27th Ave Ste 207 Phoenix AZ 85027-4015 Ph: (602) 993-2700 |
| NPI Number | 1285218750 |
|---|---|
| Provider Enumeration Date | 05/10/2021 |
| Last Update Date | 02/16/2022 |
| Certification Date | 02/16/2022 |
| Medicare PECOS PAC ID | 2163817677 |
|---|---|
| Medicare Enrollment ID | O20220321000994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285218750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| 261QP1100X | Clinic/center - Podiatric | (NU) | Secondary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (NU) | Primary |
| Provider Name | Jacob John Wolfrum |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1437649084 PECOS PAC ID: 2668853763 Enrollment ID: I20220720003958 |
| Provider Name | Kelsie S Effrein |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1114581188 PECOS PAC ID: 4981939444 Enrollment ID: I20220727004258 |
| Provider Name | Richard a Ayiyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689301293 PECOS PAC ID: 6305214677 Enrollment ID: I20221116003313 |
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