1144429333 NPI number — STEP LIVELY FOOT AND ANKLE CENTERS INC.

Table of content: (NPI 1144429333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144429333 NPI number — STEP LIVELY FOOT AND ANKLE CENTERS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEP LIVELY FOOT AND ANKLE CENTERS 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:
1144429333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 BEECHER XING N
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-4558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-304-0019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6670 PERIMETER DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43016-8056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-304-0019
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUITZ
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING REPRESENTATIVE
Authorized Official Telephone Number:
614-304-0019

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: CB1401 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0753340 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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