Provider Demographics
NPI:1417015983
Name:AAL FOOT CARE CENTERS INC.
Entity Type:Organization
Organization Name:AAL FOOT CARE CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-225-4176
Mailing Address - Street 1:1134 W ROBB AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2404
Mailing Address - Country:US
Mailing Address - Phone:419-225-4176
Mailing Address - Fax:419-225-4069
Practice Address - Street 1:1134 W ROBB AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2404
Practice Address - Country:US
Practice Address - Phone:419-225-4176
Practice Address - Fax:419-225-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0555831Medicaid
OH9227871Medicare ID - Type Unspecified
OH0555831Medicaid