Provider Demographics
NPI:1033298385
Name:NORTHCOAST FOOT AND ANKLE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHCOAST FOOT AND ANKLE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-734-5662
Mailing Address - Street 1:23823 LORAIN RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2254
Mailing Address - Country:US
Mailing Address - Phone:440-734-5662
Mailing Address - Fax:440-734-0989
Practice Address - Street 1:23823 LORAIN RD
Practice Address - Street 2:SUITE 280
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2254
Practice Address - Country:US
Practice Address - Phone:440-734-5662
Practice Address - Fax:440-734-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2390213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTH06211961Medicaid
OH395959503OtherMEDICAL MUTUAL OF OHIO
OH=========0A13OtherBLUE CROSS/BLUE SHIELD
OH=========0A13OtherBLUE CROSS/BLUE SHIELD
OH0733522Medicare ID - Type Unspecified
OH0497180001Medicare NSC