Provider Demographics
NPI:1295031748
Name:FAMILY FOOT & ANKLE CENTER INC PA
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE CENTER INC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-728-4800
Mailing Address - Street 1:8474 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4939
Mailing Address - Country:US
Mailing Address - Phone:513-728-4800
Mailing Address - Fax:513-728-4601
Practice Address - Street 1:5400 DIXIE HWY
Practice Address - Street 2:SUITE G
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7488
Practice Address - Country:US
Practice Address - Phone:513-829-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003377213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2487465Medicaid
OH6515310003Medicare NSC
OH9390251Medicare PIN