1629263132 NPI number — AVON FOOT AND ANKLE INC.

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 1629263132 NPI number — AVON FOOT AND ANKLE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVON FOOT AND ANKLE 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:
1629263132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44011-0268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-934-1469
Provider Business Mailing Address Fax Number:
440-934-3083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37452 COLORADO AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44011-0268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-934-1469
Provider Business Practice Location Address Fax Number:
440-934-3083
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-934-1469

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36002976 , 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: 2136030 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ6252 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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