Provider Demographics
NPI:1497967392
Name:STEP LIVELY FOOT AND ANKLE CENTERS INC
Entity Type:Organization
Organization Name:STEP LIVELY FOOT AND ANKLE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-304-0019
Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4558
Mailing Address - Country:US
Mailing Address - Phone:614-304-0019
Mailing Address - Fax:614-304-0023
Practice Address - Street 1:1045 BEECHER XING N
Practice Address - Street 2:STE. A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4558
Practice Address - Country:US
Practice Address - Phone:614-304-0019
Practice Address - Fax:614-304-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002316P213ES0103X
OH36002329W213ES0103X
OH36002479W213ES0103X
OH36003204D213ES0103X
OH36003275L213ES0103X
OH36003465213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCB1401OtherMEDICARE RAILROAD
OH0753340Medicaid
OH9929221Medicare PIN
OH9929224Medicare PIN
OH9929223Medicare PIN
OHCB1401OtherMEDICARE RAILROAD
OH0753340Medicaid