Organization
BRIDGETON FOOT AND ANKLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY M LOMBARDO D.P.M. (PHYSICIAN)
(314) 739-8863
Entity
Organization
Contact information
Practice address
12255 DE PAUL DR, STE. 470, BRIDGETON, MO 63044-2510
(314) 739-8863
(314) 739-6448
Mailing address
12255 DE PAUL DR, STE. 470, BRIDGETON, MO 63044-2510
(314) 739-8863
(314) 739-6448
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000551
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2700030
UHC
MO
01
—
2784098
UHC
MO
05
—
300628401
—
MO
05
—
303231500
—
MO
01
—
310171750
MEDICARE CPIN
MO
01
—
32B00000X
MEDICAID DME
MO
01
—
480034196
RR MEDICARD
MO
01
—
504595802
MEDICAID GROUP
MO
01
—
P00419552
RR MEDICARE
MO
Enumeration date
02/06/2007
Last updated
12/03/2009
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