Provider Demographics
NPI:1558313254
Name:FOOT & ANKLE CENTERS OF OHIO, INC
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTERS OF OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-394-8664
Mailing Address - Street 1:1013 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2447
Mailing Address - Country:US
Mailing Address - Phone:419-394-8664
Mailing Address - Fax:419-394-1148
Practice Address - Street 1:770 W HIGH ST, SUITE 240
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5906
Practice Address - Country:US
Practice Address - Phone:419-224-8414
Practice Address - Fax:419-224-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003084M213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092953Medicaid
OHU71353Medicare UPIN
OH2092953Medicaid