Provider Demographics
NPI:1790823417
Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Other - Org Name:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC ARNOLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-296-4051
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:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:1515 ASTRA WAY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1146
Practice Address - Country:US
Practice Address - Phone:636-296-4051
Practice Address - Fax:636-287-9547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5558370001Medicare NSC