Provider Demographics
NPI:1376642181
Name:ANTHONY E. NUMRICH PSC
Entity Type:Organization
Organization Name:ANTHONY E. NUMRICH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NUMRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-472-0102
Mailing Address - Street 1:227 N BARRON ST
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-1703
Mailing Address - Country:US
Mailing Address - Phone:937-472-0102
Mailing Address - Fax:
Practice Address - Street 1:227 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1703
Practice Address - Country:US
Practice Address - Phone:937-472-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATON FOOT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1962-OH213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0436308Medicaid
OH000000036074OtherANTHEM
OH000000036074OtherANTHEM