Provider Demographics
NPI:1679603724
Name:FOOT ANKLE SPECIALTY CENTERS, LLC
Entity type:Organization
Organization Name:FOOT ANKLE SPECIALTY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-812-3668
Mailing Address - Street 1:4915 E BASELINE ROAD
Mailing Address - Street 2:BLDG 8, SUITE 121
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2965
Mailing Address - Country:US
Mailing Address - Phone:480-812-3668
Mailing Address - Fax:480-782-1290
Practice Address - Street 1:4915 E BASELINE ROAD
Practice Address - Street 2:BLDG 8, SUITE 121
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:480-812-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1649273814OtherPAYAM SARRAF INDIV NPI
AZ1942434618OtherJAMES GARBER DPM NPI
AZ1619907755OtherTODD LAMSTER DPM NPI
AZ1679603724OtherFOOT ANKLE SPECIALTY CENTERS NPI
AZU96409Medicare UPIN
AZ1619907755OtherTODD LAMSTER DPM NPI
AZV06085Medicare UPIN
AZV09719Medicare UPIN
AZ1679603724OtherFOOT ANKLE SPECIALTY CENTERS NPI
AZ116322Medicare PIN
AZ1649273814OtherPAYAM SARRAF INDIV NPI
AZ6034950001Medicare NSC