Provider Demographics
NPI:1467889543
Name:ASHTABULA FOOT AND ANKLE SURGEONS INC
Entity Type:Organization
Organization Name:ASHTABULA FOOT AND ANKLE SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-964-5595
Mailing Address - Street 1:1604 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3036
Mailing Address - Country:US
Mailing Address - Phone:440-964-5595
Mailing Address - Fax:440-964-5003
Practice Address - Street 1:1604 W 19TH ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3036
Practice Address - Country:US
Practice Address - Phone:440-964-5595
Practice Address - Fax:440-964-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002243213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80752Medicare PIN