| Organization Name: | BERKELEY COUNTY FOOT AND ANKLE CENTER LLC |
| NPI Number: | 1801061932 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN S JACKO (OWNER) |
| Mailing Address: | 3790 Hedgesville Road Suite O Hedgesville |
| State: | WV US |
| Postal Code: | 254276704 |
| Phone Number: | 3047547130 |
| Fax Number: | 7177621831 |
| NPI Enumeration Date: | 04/29/2008 |
| NPI Last Update Date: | 05/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 10391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |