Provider Demographics
NPI:1255435897
Name:MISSOURI FOOT AND ANKLE CLINICS, P.C.
Entity type:Organization
Organization Name:MISSOURI FOOT AND ANKLE CLINICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HANON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-224-8660
Mailing Address - Street 1:256 SW WINTERPARK CIR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-4013
Mailing Address - Country:US
Mailing Address - Phone:816-224-8660
Mailing Address - Fax:816-200-9005
Practice Address - Street 1:1136 W 40 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4610
Practice Address - Country:US
Practice Address - Phone:816-224-8660
Practice Address - Fax:816-200-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000774213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4349950001OtherDMERC
CJ9038OtherRR MCR
MO506023506Medicaid
MOU75663Medicare UPIN
L410000AMedicare PIN
4349950001Medicare NSC
L410000Medicare PIN