Provider Demographics
NPI:1144617556
Name:PODIATRY INC
Entity Type:Organization
Organization Name:PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DODDS
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPB
Authorized Official - Phone:216-672-4330
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4337
Mailing Address - Country:US
Mailing Address - Phone:216-245-1290
Mailing Address - Fax:866-571-4884
Practice Address - Street 1:6563 WILSON MILLS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3409
Practice Address - Country:US
Practice Address - Phone:216-245-1290
Practice Address - Fax:866-571-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty