Provider Demographics
NPI:1083699094
Name:CENTERS FOR FOOT AND ANKLE CARE
Entity Type:Organization
Organization Name:CENTERS FOR FOOT AND ANKLE CARE
Other - Org Name:CENTERS FOR FOOT AND ANKLE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-725-3444
Mailing Address - Street 1:4650 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1836
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:3035 HAMILTON MASON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5544
Practice Address - Country:US
Practice Address - Phone:513-844-8585
Practice Address - Fax:513-844-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2128683Medicaid
CN5629Medicare PIN
OH9294773Medicare PIN
OH2128683Medicaid