Mid-West Podiatry and Associates, L L C

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

MID-WEST PODIATRY AND ASSOCIATES, L L C

Practice address

12818 Tesson Ferry Rd Ste 201
Saint Louis, MO 63128-2945

Phone

(314) 894-4684

Fax

(314) 892-0836

NPI assigned

Dec 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hieu Nguyen

Title

Administrator

Phone

(314) 432-5683

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1659436640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11709 OLD BALLAS RD STE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417029",
            "telephone_number": "314-432-1903",
            "fax_number": "314-432-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12818 TESSON FERRY RD STE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282945",
            "telephone_number": "314-894-4684",
            "fax_number": "314-892-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-WEST PODIATRY AND ASSOCIATES, L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "HIEU",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-432-5683"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "365905413",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "365905405",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.