Provider Demographics
NPI:1740653591
Name:ASSOCIATED FOOT SURGEONS OF SOUTHWEST ILLINOIS, LTD.
Entity type:Organization
Organization Name:ASSOCIATED FOOT SURGEONS OF SOUTHWEST ILLINOIS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITTENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:618-277-5700
Mailing Address - Street 1:2900 FRANK SCOTT PKWY W
Mailing Address - Street 2:STE 900
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5000
Mailing Address - Country:US
Mailing Address - Phone:618-277-5700
Mailing Address - Fax:618-257-7049
Practice Address - Street 1:2900 FRANK SCOTT PKWY W
Practice Address - Street 2:STE 900
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5000
Practice Address - Country:US
Practice Address - Phone:618-277-5700
Practice Address - Fax:618-257-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty