1922315639 NPI number — FOOT CARE SOLUTIONS, LLC

Table of content: (NPI 1922315639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922315639 NPI number — FOOT CARE SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT CARE SOLUTIONS, 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:
1922315639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 W BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43204-3333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-274-7448
Provider Business Mailing Address Fax Number:
614-274-4498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2575 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43204-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-274-7448
Provider Business Practice Location Address Fax Number:
614-274-4498
Provider Enumeration Date:
09/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAMMAD
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
614-274-7448

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36.003305 , 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: 2375826 . This is a "MCD-INDIVIDUAL-MTM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4103245 . This is a "MC-INDIVIDUAL PIN-MTM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3090597 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: N463943 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292728860-00 . This is a "BWC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000510898 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00372468 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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