1659160281 NPI number — SEVILLE PODIATRY SERVICES LLC

Table of content: (NPI 1659160281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659160281 NPI number — SEVILLE PODIATRY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEVILLE PODIATRY SERVICES 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:
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:
1659160281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6392 EQUESTRIAN TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-7421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-975-0004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6392 EQUESTRIAN TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256-7421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-975-0004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
714-404-5641

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0119929 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com