Provider Demographics
NPI:1376109660
Name:FOOT AND ANKLE SPECIALISTS OF CENTRAL OHIO LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF CENTRAL OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM-DOD
Authorized Official - Phone:740-344-8286
Mailing Address - Street 1:426 BEECHER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1797
Mailing Address - Country:US
Mailing Address - Phone:740-344-8286
Mailing Address - Fax:614-939-9299
Practice Address - Street 1:65 E GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9130
Practice Address - Country:US
Practice Address - Phone:614-939-9330
Practice Address - Fax:740-522-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3084362Medicaid