1023250248 NPI number — PODIATRY HOME HEALTH CARE

Table of content: (NPI 1023250248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023250248 NPI number — PODIATRY HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY HOME HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BARBARA L. PETKOVIC DPM
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023250248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5683 PEARL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44129-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-885-2130
Provider Business Mailing Address Fax Number:
440-848-8406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5683 PEARL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-885-2130
Provider Business Practice Location Address Fax Number:
440-848-8406
Provider Enumeration Date:
04/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PETKOVIC
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
440-885-2130

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  36003284 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2323444 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".