1194938936 NPI number — FOOT & ANKLE SURGICAL GROUP, LLP

Table of content: CRAIG A CHARLESTON MD (NPI 1952386435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194938936 NPI number — FOOT & ANKLE SURGICAL GROUP, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT & ANKLE SURGICAL GROUP, LLP
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:
6
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:
1194938936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 W LAKE MEAD PKWY
Provider Second Line Business Mailing Address:
#B-18
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89015-7055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-564-8022
Provider Business Mailing Address Fax Number:
702-558-1522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 ADAMS BLVD
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
BOULDER CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89005-2244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-293-0151
Provider Business Practice Location Address Fax Number:
702-456-6688
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STACEY
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
702-456-3668

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  38610 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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