1518909860 NPI number — ANKLE AND FOOT CARE CENTERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518909860 NPI number — ANKLE AND FOOT CARE CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANKLE AND FOOT CARE CENTERS
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:
Provider Other Organization Name Type Code:
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:
1518909860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 STATE ROUTE 14
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
COLUMBIANA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44408-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-482-1960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 STATE ROUTE 14
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
COLUMBIANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44408-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-482-1960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIDOMENICO
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
DPM
Authorized Official Telephone Number:
330-629-8800

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001496124-0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102758 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5504 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0008879000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001496124-0005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001496124-0001 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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