1679603724 NPI number — FOOT ANKLE SPECIALTY CENTERS, LLC

Table of content: MICHAEL JAMES WALLS M.D. (NPI 1679579791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679603724 NPI number — FOOT ANKLE SPECIALTY CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT ANKLE SPECIALTY CENTERS, 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:
1679603724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4915 E BASELINE ROAD
Provider Second Line Business Mailing Address:
BLDG 8, SUITE 121
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85234-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-812-3668
Provider Business Mailing Address Fax Number:
480-782-1290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4915 E BASELINE ROAD
Provider Second Line Business Practice Location Address:
BLDG 8, SUITE 121
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-812-3668
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAFIS
Authorized Official First Name:
CONSTANTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-812-3668

Provider Taxonomy Codes

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

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

  • Identifier: 1649273814 . This is a "PAYAM SARRAF INDIV NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1942434618 . This is a "JAMES GARBER DPM NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1619907755 . This is a "TODD LAMSTER DPM NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1679603724 . This is a "FOOT ANKLE SPECIALTY CENTERS NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".