Provider Demographics
NPI:1053314617
Name:CHOICE PODIATRY ASSOCIATES INC
Entity Type:Organization
Organization Name:CHOICE PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOTRING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-984-1911
Mailing Address - Street 1:PO BOX 933400
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0038
Mailing Address - Country:US
Mailing Address - Phone:513-984-1911
Mailing Address - Fax:513-984-1912
Practice Address - Street 1:8280 MONTGOMERY RD STE 103
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6101
Practice Address - Country:US
Practice Address - Phone:513-984-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821454Medicaid
OH0459267Medicaid
OH480023545Medicaid
OHCD5236OtherRAILROAD MEDICARE
OH0724694Medicaid
OH480021690OtherRAILROAD MEDICARE
OH9286871Medicare PIN
OH480021690OtherRAILROAD MEDICARE
OH0821454Medicaid