Provider Demographics
NPI:1790908234
Name:BK PODIATRY CENTERS, LLC
Entity Type:Organization
Organization Name:BK PODIATRY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-837-8477
Mailing Address - Street 1:111 FLORISSANT OAKS SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-3933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 FLORISSANT OAKS SHOP CTR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3934
Practice Address - Country:US
Practice Address - Phone:314-837-8477
Practice Address - Fax:314-837-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0000440213E00000X, 213ES0103X
MO800213E00000X, 213ES0103X
MO2001014944213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0508040001Medicare NSC
MO000011601Medicare ID - Type Unspecified