Provider Demographics
NPI:1578813945
Name:ACHILLES FOOT AND ANKLE SPECIALIST LLC
Entity Type:Organization
Organization Name:ACHILLES FOOT AND ANKLE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-586-6778
Mailing Address - Street 1:4131 DIRECTORS ROW
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8703
Mailing Address - Country:US
Mailing Address - Phone:713-586-6778
Mailing Address - Fax:713-586-6752
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-538-2161
Practice Address - Fax:480-585-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty