Provider Demographics
NPI:1518592302
Name:THIRD COAST FOOT AND ANKLE SC
Entity Type:Organization
Organization Name:THIRD COAST FOOT AND ANKLE SC
Other - Org Name:THIRD COAST FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-764-4699
Mailing Address - Street 1:7001 S HOWELL AVE # 500
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7001 S HOWELL AVE # 500
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1407
Practice Address - Country:US
Practice Address - Phone:414-764-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty