Provider Demographics
NPI:1164760765
Name:COMPLETE FOOT AND ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:COMPLETE FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-893-6942
Mailing Address - Street 1:1400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1581
Mailing Address - Country:US
Mailing Address - Phone:937-599-3668
Mailing Address - Fax:937-599-4852
Practice Address - Street 1:2330 E HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1371
Practice Address - Country:US
Practice Address - Phone:937-322-3346
Practice Address - Fax:937-599-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH015112OtherMEDICARE