Provider Demographics
NPI:1629263132
Name:AVON FOOT AND ANKLE INC.
Entity Type:Organization
Organization Name:AVON FOOT AND ANKLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-934-1469
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-0268
Mailing Address - Country:US
Mailing Address - Phone:440-934-1469
Mailing Address - Fax:440-934-3083
Practice Address - Street 1:37452 COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-0268
Practice Address - Country:US
Practice Address - Phone:440-934-1469
Practice Address - Fax:440-934-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002976213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136030Medicaid
OHCJ6252OtherRAILROAD MEDICARE
OHCJ6252OtherRAILROAD MEDICARE
OH9319351Medicare PIN