Provider Demographics
NPI:1235433715
Name:PODIATRY PARTNERS INC
Entity Type:Organization
Organization Name:PODIATRY PARTNERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-923-9090
Mailing Address - Street 1:9105A INDIANAPOLIS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2591
Mailing Address - Country:US
Mailing Address - Phone:219-923-9090
Mailing Address - Fax:219-923-9147
Practice Address - Street 1:9105A INDIANAPOLIS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2591
Practice Address - Country:US
Practice Address - Phone:219-923-9090
Practice Address - Fax:219-923-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
IN07001113A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2010237000Medicaid
M100040452Medicare PIN
6967950001Medicare NSC