Basic Information
| Provider Information | |||||||||
| NPI: | 1992000426 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEXT STEP FOOT & ANKLE CENTERS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TESSON FERRY FOOT AND ANKLE | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3505 COLLEGE AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620025065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629695 | ||||||||
| FaxNumber: | 6184629651 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 S MAIN ST | ||||||||
| Address2: | STE B | ||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620251921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183079015 | ||||||||
| FaxNumber: | 6183079017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | BARTH | ||||||||
| AuthorizedOfficialFirstName: | LINDSAY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6184626965 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.