Provider Demographics
NPI:1598776981
Name:PODIATRIC ASSOCIATES OF NORTHWEST OHIO, INC.
Entity Type:Organization
Organization Name:PODIATRIC ASSOCIATES OF NORTHWEST OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-893-5539
Mailing Address - Street 1:3905 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4426
Mailing Address - Country:US
Mailing Address - Phone:419-474-1210
Mailing Address - Fax:419-474-3076
Practice Address - Street 1:3905 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4426
Practice Address - Country:US
Practice Address - Phone:419-474-1210
Practice Address - Fax:419-474-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2862282Medicaid
OHCB0314Medicare PIN
OH9929962Medicare PIN
OH0537250004Medicare NSC