Provider Demographics
NPI:1154674851
Name:RICHMOND FOOT AND ANKLE INC
Entity Type:Organization
Organization Name:RICHMOND FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OFFUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-965-3668
Mailing Address - Street 1:1106 S A ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5526
Mailing Address - Country:US
Mailing Address - Phone:765-965-3668
Mailing Address - Fax:765-965-6530
Practice Address - Street 1:1106 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5526
Practice Address - Country:US
Practice Address - Phone:765-965-3668
Practice Address - Fax:765-965-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000991213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200268880Medicaid
IN200268880Medicaid
INV02312Medicare UPIN