Provider Demographics
NPI:1003819186
Name:CENTRAL OHIO FOOT AND ANKLE INC
Entity Type:Organization
Organization Name:CENTRAL OHIO FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-252-8637
Mailing Address - Street 1:393 E TOWN ST
Mailing Address - Street 2:SUITE 229
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4741
Mailing Address - Country:US
Mailing Address - Phone:614-252-8637
Mailing Address - Fax:
Practice Address - Street 1:393 E TOWN ST
Practice Address - Street 2:SUITE 229
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4741
Practice Address - Country:US
Practice Address - Phone:614-252-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002890213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0376249Medicaid
OHCD3986OtherRAILROAD MEDICARE
OH9289781Medicare PIN
OH0376249Medicaid