Provider Demographics
NPI:1245558931
Name:FOOT AND ANKLE SURGICAL ASSISTANTS LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-447-1000
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0909
Mailing Address - Country:US
Mailing Address - Phone:719-576-4171
Mailing Address - Fax:
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2602
Practice Address - Country:US
Practice Address - Phone:719-576-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty