Provider Demographics
NPI:1659488559
Name:ANKLE AND FOOT CARE CENTERS
Entity Type:Organization
Organization Name:ANKLE AND FOOT CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-629-8800
Mailing Address - Street 1:8511 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINSMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44428-9333
Mailing Address - Country:US
Mailing Address - Phone:866-903-4180
Mailing Address - Fax:330-876-3808
Practice Address - Street 1:8511 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINSMAN
Practice Address - State:OH
Practice Address - Zip Code:44428-9333
Practice Address - Country:US
Practice Address - Phone:866-903-4180
Practice Address - Fax:330-876-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102758Medicaid
OH5504OtherRAILROAD MEDICARE
OH0996920018Medicare NSC
OH5504OtherRAILROAD MEDICARE