1477737054 NPI number — GITERSONKE FOOT CLINIC, PC

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 1477737054 NPI number — GITERSONKE FOOT CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GITERSONKE FOOT CLINIC, PC
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:
1477737054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2412 CORPORATE CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITE CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62040-4192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-931-3338
Provider Business Mailing Address Fax Number:
618-931-4905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62249-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-654-2383
Provider Business Practice Location Address Fax Number:
618-931-4905
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GITERSONKE
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
DOLORES
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
618-654-2383

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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