Provider Demographics
NPI:1255486122
Name:BELMONT PODIATRY INC
Entity Type:Organization
Organization Name:BELMONT PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOLENICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-676-7766
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-0327
Mailing Address - Country:US
Mailing Address - Phone:740-676-7766
Mailing Address - Fax:
Practice Address - Street 1:3000 GUERNSEY ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1540
Practice Address - Country:US
Practice Address - Phone:740-676-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002878332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55063Medicare UPIN
OH4398290001Medicare NSC