Provider Demographics
NPI:1225399363
Name:CAPITAL CITY FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:CAPITAL CITY FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAYNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-597-8303
Mailing Address - Street 1:1570 FISHINGER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2114
Mailing Address - Country:US
Mailing Address - Phone:614-451-7033
Mailing Address - Fax:
Practice Address - Street 1:1570 FISHINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2114
Practice Address - Country:US
Practice Address - Phone:614-451-7033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03618213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6710700001Medicare NSC
OHH100910Medicare PIN