Provider Demographics
NPI:1891748471
Name:FOOT & ANKLE SURGICAL GROUP, LLP
Entity Type:Organization
Organization Name:FOOT & ANKLE SURGICAL GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TORGESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-456-3668
Mailing Address - Street 1:10561 JEFFREYS ST
Mailing Address - Street 2:#110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4266
Mailing Address - Country:US
Mailing Address - Phone:702-456-3668
Mailing Address - Fax:702-456-6688
Practice Address - Street 1:10561 JEFFREYS ST
Practice Address - Street 2:#110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4266
Practice Address - Country:US
Practice Address - Phone:702-456-3668
Practice Address - Fax:702-456-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
NV8601332900000X
NV38610332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2990162OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NVDB6830Medicare PIN
NV5277230001Medicare NSC
NVV38604Medicare PIN
2990162OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NV5277230003Medicare NSC