Provider Demographics
NPI:1902946387
Name:TESSON FERRY FOOT AND ANKLE, INC
Entity Type:Organization
Organization Name:TESSON FERRY FOOT AND ANKLE, INC
Other - Org Name:ALTON FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-909-1920
Mailing Address - Street 1:2315 DOUGHERTY FERRY RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3383
Mailing Address - Country:US
Mailing Address - Phone:314-909-1920
Mailing Address - Fax:
Practice Address - Street 1:3505 COLLEGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5065
Practice Address - Country:US
Practice Address - Phone:618-462-9695
Practice Address - Fax:618-462-9651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TESSON FERRY FOOT AND ANKLE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2922740002Medicare NSC