Provider Demographics
NPI:1487692687
Name:MCKENZIE HASTINGS INSTITUTE FOR FOOT & ANKLE SURGERY, LLC
Entity type:Organization
Organization Name:MCKENZIE HASTINGS INSTITUTE FOR FOOT & ANKLE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-638-1823
Mailing Address - Street 1:1520 BREEZEPORT WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3726
Mailing Address - Country:US
Mailing Address - Phone:757-638-1823
Mailing Address - Fax:757-638-1824
Practice Address - Street 1:1520 BREEZEPORT WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3726
Practice Address - Country:US
Practice Address - Phone:757-638-1823
Practice Address - Fax:757-638-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5528650001Medicare NSC
VAC09552Medicare PIN