1730167156 NPI number — TRIAD FOOT AND ANKLE SPECIALISTS, LLC

Table of content: (NPI 1730167156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730167156 NPI number — TRIAD FOOT AND ANKLE SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIAD FOOT AND ANKLE SPECIALISTS, 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:
1730167156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070-0093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-777-6017
Provider Business Mailing Address Fax Number:
440-777-6940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15644 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-226-9108
Provider Business Practice Location Address Fax Number:
216-226-9108
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIESEL
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
216-226-9108

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA5380 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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