Provider Demographics
NPI:1033871827
Name:ANKLE AND FOOT CENTERS OF MISSOURI P.C.
Entity Type:Organization
Organization Name:ANKLE AND FOOT CENTERS OF MISSOURI P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKILIS
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:THEOHARIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-436-7900
Mailing Address - Street 1:407 NE 76TH TER
Mailing Address - Street 2:
Mailing Address - City:GLANDSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1708
Mailing Address - Country:US
Mailing Address - Phone:816-436-7900
Mailing Address - Fax:816-436-0999
Practice Address - Street 1:407 NE 76TH TER
Practice Address - Street 2:
Practice Address - City:GLANDSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1708
Practice Address - Country:US
Practice Address - Phone:816-436-7900
Practice Address - Fax:816-436-0999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKLE AND FOOT CENTERS OF MISSOURI P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory