Provider Demographics
NPI:1447568043
Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Other - Org Name:MO FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-991-3668
Mailing Address - Street 1:PO BOX 771754
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-1754
Mailing Address - Country:US
Mailing Address - Phone:314-872-1332
Mailing Address - Fax:
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2146
Practice Address - Country:US
Practice Address - Phone:636-256-5298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty