Provider Demographics
NPI:1831335819
Name:ANKLE AND FOOT INSTITUTE OF MISSOURI P.C.
Entity type:Organization
Organization Name:ANKLE AND FOOT INSTITUTE OF MISSOURI P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:WITTOCK
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-717-1100
Mailing Address - Street 1:1011 BOWLES AVENUE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026
Mailing Address - Country:US
Mailing Address - Phone:636-717-1100
Mailing Address - Fax:
Practice Address - Street 1:1011 BOWLES AVENUE
Practice Address - Street 2:SUITE 123
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026
Practice Address - Country:US
Practice Address - Phone:636-717-1100
Practice Address - Fax:636-717-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2002003866213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6243950001Medicare NSC
MOU76476Medicare UPIN