1700180346 NPI number — NEXT STEP FOOT AND ANKLE CENTERS, INC

Table of content: (NPI 1700180346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700180346 NPI number — NEXT STEP FOOT AND ANKLE CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXT STEP FOOT AND ANKLE CENTERS, INC
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:
TESSON FERRY FOOT & ANKLE, INC.
Provider Other Organization Name Type Code:
4
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:
1700180346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 COLLEGE AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62002-5065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-462-9695
Provider Business Mailing Address Fax Number:
618-462-9651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 DOUGHERTY FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-909-1920
Provider Business Practice Location Address Fax Number:
314-909-1980
Provider Enumeration Date:
12/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BARTH
Authorized Official First Name:
LINDSAY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
618-462-9695

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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