1003164518 NPI number — FAMILY FOOT & ANKLE CENTER INC PA

Table of content: (NPI 1003164518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003164518 NPI number — FAMILY FOOT & ANKLE CENTER INC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FOOT & ANKLE CENTER INC PA
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:
1003164518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8474 WINTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45231-4939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-728-4800
Provider Business Mailing Address Fax Number:
513-728-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4450 EASTGATE BLVD
Provider Second Line Business Practice Location Address:
#232
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45245-1591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-752-2247
Provider Business Practice Location Address Fax Number:
513-752-2301
Provider Enumeration Date:
08/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-728-4800

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36.003377 , 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: 3081230 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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