1700824117 NPI number — PODIATRY ASSOCIATES OF EASTERN OH 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 1700824117 NPI number — PODIATRY ASSOCIATES OF EASTERN OH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY ASSOCIATES OF EASTERN OH 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:
1700824117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 N 5TH ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
MARTINS FERRY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-633-4180
Provider Business Mailing Address Fax Number:
740-633-4395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 N 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MARTINS FERRY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-633-4180
Provider Business Practice Location Address Fax Number:
740-633-4395
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAFFNEY
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-633-4180

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36003025G , 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: 3025E . This is a "UPPER OH VALLEY HLTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001708264 . This is a "MOUNTAIN STATE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000140720 . This is a "ANTHEM BLUE CROSS SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2019943 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4800256391 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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