1063599033 NPI number — ANKLE & FOOT CLINIC, INC.

Table of content: (NPI 1063599033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063599033 NPI number — ANKLE & FOOT CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANKLE & FOOT CLINIC, 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:
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:
1063599033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4789 LEAVITT RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LORAIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44053-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-246-1200
Provider Business Mailing Address Fax Number:
440-246-2275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4789 LEAVITT RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44053-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-246-1200
Provider Business Practice Location Address Fax Number:
440-246-2275
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-246-1200

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  36003106 , 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: 7361316 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DN6482 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000230200 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2865118 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: E03106 . This is a "SUMMA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 270646406 . This is a "EMERALD HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 270646406 . This is a "OHIO HEALTH CHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 270646406004 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04374 . This is a "KAISER PERM." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 21203 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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