Provider Demographics
NPI:1619357670
Name:BOWLING GREEN FOOT AND ANKLE PHYSICIANS INC
Entity Type:Organization
Organization Name:BOWLING GREEN FOOT AND ANKLE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-352-8110
Mailing Address - Street 1:735 HASKINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1638
Mailing Address - Country:US
Mailing Address - Phone:419-352-8110
Mailing Address - Fax:419-354-1425
Practice Address - Street 1:735 HASKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1638
Practice Address - Country:US
Practice Address - Phone:419-352-8110
Practice Address - Fax:419-354-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003736213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145216Medicaid
OH7427420001Medicare NSC
OHDW0072Medicare PIN
OHH357740Medicare PIN