Provider Demographics
NPI:1568798908
Name:GENTLE FOOT CARE OF WESTERN OHIO
Entity Type:Organization
Organization Name:GENTLE FOOT CARE OF WESTERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-239-0399
Mailing Address - Street 1:3255 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1923
Mailing Address - Country:US
Mailing Address - Phone:614-239-0399
Mailing Address - Fax:614-237-5220
Practice Address - Street 1:3800 WOODWARD AVE
Practice Address - Street 2:STE 1102
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2061
Practice Address - Country:US
Practice Address - Phone:313-833-3090
Practice Address - Fax:313-833-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6216330001OtherDMERCK
MI1316191679Medicaid
MI1316191679Medicaid