Provider Demographics
NPI:1619981479
Name:FOOT AND ANKLE SURGERY FACILITY, LTD
Entity Type:Organization
Organization Name:FOOT AND ANKLE SURGERY FACILITY, LTD
Other - Org Name:REGENERATIVE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-390-7666
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-0924
Mailing Address - Country:US
Mailing Address - Phone:847-390-7666
Mailing Address - Fax:847-390-9345
Practice Address - Street 1:1455 E GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1250
Practice Address - Country:US
Practice Address - Phone:847-390-7666
Practice Address - Fax:847-390-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7001803261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1501OtherBCBS
IL1501OtherBCBS
IL141068Medicare PIN