Provider Demographics
NPI:1467673145
Name:ADVANCED PODIATRY CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED PODIATRY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOSKING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-282-1312
Mailing Address - Street 1:4751 OBERLIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3401
Mailing Address - Country:US
Mailing Address - Phone:440-282-1312
Mailing Address - Fax:440-282-1319
Practice Address - Street 1:4751 OBERLIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3401
Practice Address - Country:US
Practice Address - Phone:440-282-1312
Practice Address - Fax:440-282-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131491Medicaid
OH4761660001Medicare NSC
OH2131491Medicaid
OHSP00582Medicare PIN