1366408205 NPI number — FOOT & ANKLE CENTER, LLC

Table of content: (NPI 1366408205)

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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