Provider Demographics
NPI:1164054169
Name:MCKENZIE INSTITUTE FOR FOOT & ANKLE SURGERY
Entity Type:Organization
Organization Name:MCKENZIE INSTITUTE FOR FOOT & ANKLE SURGERY
Other - Org Name:MCKENZIE FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-977-1026
Mailing Address - Street 1:3907 BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1133
Mailing Address - Country:US
Mailing Address - Phone:757-977-1026
Mailing Address - Fax:757-977-1027
Practice Address - Street 1:3907 BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1133
Practice Address - Country:US
Practice Address - Phone:757-977-1026
Practice Address - Fax:757-977-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty