Provider Demographics
NPI:1043221237
Name:DONAHUE FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:DONAHUE FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-459-8616
Mailing Address - Street 1:3731 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2750
Mailing Address - Country:US
Mailing Address - Phone:216-459-8616
Mailing Address - Fax:216-459-0373
Practice Address - Street 1:26151 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3300
Practice Address - Country:US
Practice Address - Phone:216-459-8616
Practice Address - Fax:216-459-0373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONAHUE FOOT AND ANKLE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002283213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2691921Medicaid
OH000000167628OtherANTHEM BLUE SHIELD
OH2691921Medicaid
OH0558560002Medicare NSC
OH9255171Medicare PIN
OHDD2629Medicare PIN