Provider Demographics
NPI:1144537523
Name:HENDERSON FOOT AND ANKLE CENTER LLC
Entity type:Organization
Organization Name:HENDERSON FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-435-7987
Mailing Address - Street 1:1485 W WARM SPRINGS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7632
Mailing Address - Country:US
Mailing Address - Phone:702-435-7987
Mailing Address - Fax:702-435-7616
Practice Address - Street 1:1485 W WARM SPRINGS RD STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7632
Practice Address - Country:US
Practice Address - Phone:702-435-7987
Practice Address - Fax:702-435-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1008332B00000X, 261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEG369AMedicare UPIN
NV6465720001Medicare NSC