Provider Demographics
NPI:1730233743
Name:GEISTLER FAMILY FOOTCARE, INC.
Entity type:Organization
Organization Name:GEISTLER FAMILY FOOTCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-849-7600
Mailing Address - Street 1:12700 SOUTHFORK RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3288
Mailing Address - Country:US
Mailing Address - Phone:314-849-7600
Mailing Address - Fax:314-849-9004
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-849-7600
Practice Address - Fax:314-842-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000612213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507338101Medicaid
MOU30241Medicare UPIN
MO5820380001Medicare NSC
MO507338101Medicaid