Provider Demographics
NPI:1013182070
Name:OHIO FOOT CARE INC.
Entity Type:Organization
Organization Name:OHIO FOOT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VACHERESSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-901-0000
Mailing Address - Street 1:855 W COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9587
Mailing Address - Country:US
Mailing Address - Phone:614-901-0000
Mailing Address - Fax:614-901-4117
Practice Address - Street 1:245 NEAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9372
Practice Address - Country:US
Practice Address - Phone:419-946-6000
Practice Address - Fax:614-901-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305991Medicaid
OH2944247Medicaid
OH2305991Medicaid
OH2944247Medicaid