Provider Demographics
NPI:1245931138
Name:FOOT AND ANKLE SURGICAL SPECIALIST INC.
Entity type:Organization
Organization Name:FOOT AND ANKLE SURGICAL SPECIALIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-623-3347
Mailing Address - Street 1:9901 LURLINE AVE APT 221
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4600
Mailing Address - Country:US
Mailing Address - Phone:801-623-3347
Mailing Address - Fax:
Practice Address - Street 1:9901 LURLINE AVE APT 221
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4600
Practice Address - Country:US
Practice Address - Phone:801-623-3347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric