Provider Demographics
NPI:1518079029
Name:FALLS FOOT AND ANKLE CLINIC, INC.
Entity Type:Organization
Organization Name:FALLS FOOT AND ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-655-7679
Mailing Address - Street 1:PO BOX 1811
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-0811
Mailing Address - Country:US
Mailing Address - Phone:330-655-7679
Mailing Address - Fax:330-922-4202
Practice Address - Street 1:421 GRAHAM RD
Practice Address - Street 2:SUITE D
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1344
Practice Address - Country:US
Practice Address - Phone:330-922-0114
Practice Address - Fax:330-922-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002645213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCG4299OtherRAILROAD MEDICARE
OH27164724300OtherBWC INDIVIDUAL
OH0811410Medicaid
OH0811410Medicaid
OH27164724300OtherBWC INDIVIDUAL
OHCG4299OtherRAILROAD MEDICARE
OHFA9290161Medicare ID - Type UnspecifiedMDC GROUP
OHRA0679238Medicare PIN
OH0811410Medicaid