Provider Demographics
NPI:1629287339
Name:VINCE J. CODA AND ASSOCIATES
Entity Type:Organization
Organization Name:VINCE J. CODA AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CODA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:260-347-2833
Mailing Address - Street 1:410 E MITCHELL ST
Mailing Address - Street 2:P O BOX 545
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-1890
Mailing Address - Country:US
Mailing Address - Phone:260-347-2833
Mailing Address - Fax:
Practice Address - Street 1:410 E MITCHELL ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1890
Practice Address - Country:US
Practice Address - Phone:260-347-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000383A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN$$$$$$$$$OtherSOCIAL SECURITY
IN000000077974OtherANTHEM BLUE CROSS BLUE SH
IN07000383AOtherINDIANA STATE MED LICENSE