1508943895 NPI number — GENTLE FOOTCARE LLC

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 1508943895 NPI number — GENTLE FOOTCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENTLE FOOTCARE LLC
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:
GENTLE FOOT CARE INC
Provider Other Organization Name Type Code:
4
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:
1508943895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27940
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43227-0940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-239-9444
Provider Business Mailing Address Fax Number:
142-391-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 E US HIGHWAY 36, STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43078-1889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-645-0102
Provider Business Practice Location Address Fax Number:
937-650-4650
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
614-239-9444

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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