1396841532 NPI number — PODIATRY OF HAMILTON INC

Table of content: (NPI 1396841532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396841532 NPI number — PODIATRY OF HAMILTON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY OF HAMILTON INC
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:
CENTER FOR FOOT CARE
Provider Other Organization Name Type Code:
3
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:
1396841532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6770 CINCINNATI DAYTON RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LIBERTY TOWNSHIP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45044-9318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-729-4455
Provider Business Mailing Address Fax Number:
513-644-4993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6770 CINCINNATI DAYTON RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LIBERTY TOWNSHIP
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45044-9318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-729-4455
Provider Business Practice Location Address Fax Number:
513-644-4993
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BELTZ
Authorized Official First Name:
LONA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
513-644-7913

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1359 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 2794 , 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: CH7777 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CA0586 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2207767 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100325490 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".