1013182070 NPI number — OHIO FOOT CARE INC.

Table of content: (NPI 1013182070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013182070 NPI number — OHIO FOOT CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO FOOT CARE 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:
1013182070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 W COSHOCTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43031-9587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-901-0000
Provider Business Mailing Address Fax Number:
614-901-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 NEAL AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MOUNT GILEAD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43338-9372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-946-6000
Provider Business Practice Location Address Fax Number:
614-901-4117
Provider Enumeration Date:
04/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VACHERESSE
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-901-0000

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36003295 , 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: 2305991 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2944247 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".