Healthcare Provider Details

I. General information

NPI: 1366408205
Provider Name (Legal Business Name): FOOT & ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 REAVIS BARRACKS RD
SAINT LOUIS MO
63125-3260
US

IV. Provider business mailing address

1299 REAVIS BARRACKS RD
SAINT LOUIS MO
63125-3260
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-9300
  • Fax: 314-487-0120
Mailing address:
  • Phone: 314-487-9300
  • Fax: 314-487-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000481
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003754
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004898
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2004019390
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005263
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2001012399
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000540
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004166
License Number StateIL
# 9
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000806
License Number StateMO

VIII. Authorized Official

Name: LOUIS AQUINO
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 314-487-9300