Healthcare Provider Details

I. General information

NPI: 1053614644
Provider Name (Legal Business Name): BARRETT FOOT AND ANKLE CENTERS LAS VEGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 SIENA HEIGHTS DR SUITE 200
HENDERSON NV
89052-4167
US

IV. Provider business mailing address

PO BOX 924109
HOUSTON TX
77292-4109
US

V. Phone/Fax

Practice location:
  • Phone: 702-824-9655
  • Fax: 702-889-4213
Mailing address:
  • Phone: 713-586-6705
  • Fax: 713-586-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA C KELLNER
Title or Position: DIRECTOR OF MEDICAL CREDENTIALING
Credential:
Phone: 713-586-6705