Healthcare Provider Details

I. General information

NPI: 1669745501
Provider Name (Legal Business Name): WEST COUNTY FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 300A
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

10004 KENNERLY RD STE 300A
SAINT LOUIS MO
63128-5110
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-4443
  • Fax:
Mailing address:
  • Phone: 314-543-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateMO

VIII. Authorized Official

Name: ANNA DESAIX
Title or Position: PRESIDENT
Credential: DPM
Phone: 636-333-4500