Provider Demographics
NPI:1669768719
Name:FFAS PC
Entity type:Organization
Organization Name:FFAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NSIMA
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:USEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-423-4220
Mailing Address - Street 1:1628 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2304
Mailing Address - Country:US
Mailing Address - Phone:724-284-1333
Mailing Address - Fax:734-284-1311
Practice Address - Street 1:1628 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2304
Practice Address - Country:US
Practice Address - Phone:724-284-1333
Practice Address - Fax:734-284-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDF5292OtherRAILROAD MEDICARE
MIV06751Medicare UPIN