Provider Demographics
NPI:1326228438
Name:MISSOURI FOOT AND ANKLE INSTITUTE
Entity Type:Organization
Organization Name:MISSOURI FOOT AND ANKLE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM MBA
Authorized Official - Phone:636-239-0018
Mailing Address - Street 1:851 E 5TH ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3135
Mailing Address - Country:US
Mailing Address - Phone:636-239-0018
Mailing Address - Fax:636-239-0081
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 228
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-239-0018
Practice Address - Fax:636-239-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000689213ES0103X, 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
MO306649021Medicaid
MOT31258Medicare UPIN
MO6068460001Medicare NSC
MO000015537Medicare PIN