Provider Demographics
NPI:1346644200
Name:FOOT AND ANKLE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE MEDICAL CENTER LLC
Other - Org Name:SPRINGBORO PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-746-0586
Mailing Address - Street 1:766 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-3020
Mailing Address - Country:US
Mailing Address - Phone:937-746-0586
Mailing Address - Fax:
Practice Address - Street 1:766 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-3020
Practice Address - Country:US
Practice Address - Phone:937-746-0586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH067590Medicare PIN