Provider Demographics
NPI:1578602330
Name:NORTHEAST OHIO FOOT, ANKLE AND WOUND CENTER, INC
Entity Type:Organization
Organization Name:NORTHEAST OHIO FOOT, ANKLE AND WOUND CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAPOLLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-448-6222
Mailing Address - Street 1:8588 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2339
Mailing Address - Country:US
Mailing Address - Phone:330-856-4444
Mailing Address - Fax:330-856-9033
Practice Address - Street 1:7264 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9691
Practice Address - Country:US
Practice Address - Phone:330-448-6222
Practice Address - Fax:330-448-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002617213ES0103X
PASC003389213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2319128Medicaid
OH9321853Medicare ID - Type Unspecified
OH2319128Medicaid