Provider Demographics
NPI:1598949273
Name:AUSTINTOWN PODIATRY ASSOCIATES INC
Entity Type:Organization
Organization Name:AUSTINTOWN PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-792-6519
Mailing Address - Street 1:3802 ELM RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2600
Mailing Address - Country:US
Mailing Address - Phone:330-372-1500
Mailing Address - Fax:330-372-1502
Practice Address - Street 1:3802 ELM RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2600
Practice Address - Country:US
Practice Address - Phone:330-372-1500
Practice Address - Fax:330-372-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3137F213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0835949Medicaid
OH0835949Medicaid