Provider Demographics
NPI:1013204692
Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY, INC.
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY, INC.
Other - Org Name:MO FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-991-3668
Mailing Address - Street 1:PO BOX 771754
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-1754
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:314-991-3668
Practice Address - Fax:314-991-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty