1366408205 NPI number — FOOT & ANKLE CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366408205 NPI number — FOOT & ANKLE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT & ANKLE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366408205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1299 REAVIS BARRACKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63125-3260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-487-9300
Provider Business Mailing Address Fax Number:
314-487-9338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1299 REAVIS BARRACKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125-3260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-487-9300
Provider Business Practice Location Address Fax Number:
314-487-0120
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AQUINO
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
314-487-9300

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0000481 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 016003754 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 000806 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 016004898 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 2004019390 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 016005263 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 2001012399 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 000540 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 016004166 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4461710007 . This is a "MEDICARE DMERC GC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710005 . This is a "MEDICARE DMERC LSTL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710002 . This is a "DMERC MO BAP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710010 . This is a "MEDICARE DMERC PINCKNEY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710008 . This is a "MEDICARE DMERC FH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710009 . This is a "MEDICARE DMERC WATERLOO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710003 . This is a "DMERC ST CHARLES" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710004 . This is a "MEDICARE DMERC N COUNTY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4461710006 . This is a "MEDICARE DMERC SUNSET HIL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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