Provider Demographics
NPI:1144429333
Name:STEP LIVELY FOOT AND ANKLE CENTERS INC.
Entity Type:Organization
Organization Name:STEP LIVELY FOOT AND ANKLE CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-304-0019
Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4558
Mailing Address - Country:US
Mailing Address - Phone:614-304-0019
Mailing Address - Fax:
Practice Address - Street 1:6670 PERIMETER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8056
Practice Address - Country:US
Practice Address - Phone:614-304-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCB1401OtherMEDICARE RAILROAD
OH0753340Medicaid
OH0433310001Medicare NSC
OHCB1401OtherMEDICARE RAILROAD