Basic Information
| Provider Information | |||||||||
| NPI: | 1063994580 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEXT STEP FOOT AND ANKLE CENTERS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3505 COLLEGE AVE STE B | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620025065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629695 | ||||||||
| FaxNumber: | 6184629651 | ||||||||
| Practice Location | |||||||||
| Address1: | 3505 COLLEGE AVE STE B | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620025065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629695 | ||||||||
| FaxNumber: | 6184629651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2018 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | FORCE | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6184629695 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.