Provider Demographics
NPI:1518261585
Name:FOOT & ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER, LLC
Other - Org Name:F & A CENTER CLARKSON VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-487-9300
Mailing Address - Street 1:1299 REAVIS BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3260
Mailing Address - Country:US
Mailing Address - Phone:314-487-9300
Mailing Address - Fax:
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:314-487-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT & ANKLE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-05
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000540213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty