Provider Demographics
NPI:1083064182
Name:ATHENS MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ATHENS MEDICAL ASSOCIATES, LLC
Other - Org Name:ATHENS MEDICAL ASSOCIATES PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEENROD
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:740-566-4662
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:740-592-5799
Mailing Address - Fax:
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-592-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002856213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAT9351201Medicare PIN