Provider Demographics
NPI:1366408205
Name:FOOT & ANKLE CENTER, LLC
Entity type:Organization
Organization Name:FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-487-9300
Mailing Address - Street 1:1299 REAVIS BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3260
Mailing Address - Country:US
Mailing Address - Phone:314-487-9300
Mailing Address - Fax:314-487-9338
Practice Address - Street 1:1299 REAVIS BARRACKS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3260
Practice Address - Country:US
Practice Address - Phone:314-487-9300
Practice Address - Fax:314-487-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0000481213ES0103X
IL016003754213ES0103X
IL016004898213ES0103X
MO2004019390213ES0103X
MO016005263213ES0103X
MO2001012399213ES0103X
MO000540213ES0103X
IL016004166213ES0103X
MO000806213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4461710007OtherMEDICARE DMERC GC
MO4461710005OtherMEDICARE DMERC LSTL
MO4461710002OtherDMERC MO BAP
IL4461710010OtherMEDICARE DMERC PINCKNEY
IL4461710008OtherMEDICARE DMERC FH
IL4461710009OtherMEDICARE DMERC WATERLOO
MO4461710003OtherDMERC ST CHARLES
MO4461710004OtherMEDICARE DMERC N COUNTY
MO4461710006OtherMEDICARE DMERC SUNSET HIL
MO4461710006OtherMEDICARE DMERC SUNSET HIL
IL4461710010OtherMEDICARE DMERC PINCKNEY
MO4461710003OtherDMERC ST CHARLES
MO4461710004OtherMEDICARE DMERC N COUNTY