Provider Demographics
NPI:1609179506
Name:STEP LIVELY FOOT AND ANKLE CENTERS INC
Entity Type:Organization
Organization Name:STEP LIVELY FOOT AND ANKLE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-304-0019
Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4573
Mailing Address - Country:US
Mailing Address - Phone:614-304-0019
Mailing Address - Fax:614-304-0023
Practice Address - Street 1:3387 FARM BANK WAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1973
Practice Address - Country:US
Practice Address - Phone:614-782-3668
Practice Address - Fax:614-782-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0753340Medicaid
OHDP4315OtherMEDICARE RAILROAD
OHDP4315OtherMEDICARE RAILROAD
OH0433310006Medicare NSC