Provider Demographics
NPI:1669745501
Name:WEST COUNTY FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:WEST COUNTY FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAIX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-333-4500
Mailing Address - Street 1:10004 KENNERLY RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-5110
Mailing Address - Country:US
Mailing Address - Phone:314-543-5960
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD STE 300A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-270-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6727350001Medicare NSC