Provider Demographics
NPI:1073553327
Name:RICHLAND PODIATRY PC
Entity Type:Organization
Organization Name:RICHLAND PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-629-9783
Mailing Address - Street 1:8992 E D AVE
Mailing Address - Street 2:
Mailing Address - City:RRICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083
Mailing Address - Country:US
Mailing Address - Phone:269-629-9783
Mailing Address - Fax:269-629-9794
Practice Address - Street 1:8992 E D AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083
Practice Address - Country:US
Practice Address - Phone:269-629-9783
Practice Address - Fax:269-629-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000995213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2117218Medicaid
MIT97289Medicare UPIN
MI5395007Medicare ID - Type Unspecified
MI5395007Medicare PIN
MI2117218Medicaid