Provider Demographics
NPI:1336875509
Name:FOOT ANKLE SPECIALTY CENTERS, LLC
Entity Type:Organization
Organization Name:FOOT ANKLE SPECIALTY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAFIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-812-3668
Mailing Address - Street 1:4915 E BASELINE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2969
Mailing Address - Country:US
Mailing Address - Phone:480-812-3668
Mailing Address - Fax:
Practice Address - Street 1:4915 E BASELINE RD STE 121
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2969
Practice Address - Country:US
Practice Address - Phone:480-812-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT ANKLE SPECIALTY CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory