Provider Demographics
NPI:1265464820
Name:FOOT & ANKLE CONCEPTS, INC
Entity Type:Organization
Organization Name:FOOT & ANKLE CONCEPTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANGROUDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-988-3338
Mailing Address - Street 1:2100 SOLAR DR.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-988-3338
Mailing Address - Fax:805-830-1537
Practice Address - Street 1:2100 SOLAR DR.
Practice Address - Street 2:SUITE #102
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-988-3338
Practice Address - Fax:805-830-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4469213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5652140001Medicare NSC
CAW1950AMedicare PIN