Provider Demographics
NPI:1053614644
Name:BARRETT FOOT AND ANKLE CENTERS LAS VEGAS
Entity type:Organization
Organization Name:BARRETT FOOT AND ANKLE CENTERS LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-586-6705
Mailing Address - Street 1:PO BOX 924109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-4109
Mailing Address - Country:US
Mailing Address - Phone:713-586-6705
Mailing Address - Fax:713-586-6752
Practice Address - Street 1:2865 SIENA HEIGHTS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4167
Practice Address - Country:US
Practice Address - Phone:702-824-9655
Practice Address - Fax:702-889-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric