Provider Demographics
NPI:1588406128
Name:FOOT AND ANKLE SPECIALIST
Entity type:Organization
Organization Name:FOOT AND ANKLE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-213-9093
Mailing Address - Street 1:9056 PROCYON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-8115
Mailing Address - Country:US
Mailing Address - Phone:702-239-3132
Mailing Address - Fax:
Practice Address - Street 1:6120 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6760
Practice Address - Country:US
Practice Address - Phone:702-213-9093
Practice Address - Fax:702-483-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty