Provider Demographics
NPI:1669502670
Name:WADSWORTH FOOT & ANKLE, LLC
Entity Type:Organization
Organization Name:WADSWORTH FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-336-7075
Mailing Address - Street 1:229 LEATHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9236
Mailing Address - Country:US
Mailing Address - Phone:330-336-7075
Mailing Address - Fax:330-336-4211
Practice Address - Street 1:229 LEATHERMAN RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9236
Practice Address - Country:US
Practice Address - Phone:330-336-7075
Practice Address - Fax:330-336-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003282213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2375488Medicaid
OH000000329689OtherANTHEM
OH240517OtherCIGNA
OH106409OtherNATIONWIDE HEALTH PLANS
OH5127460001OtherADMIN FED
OH1528007002OtherNPI TYPE 1
OH106409OtherNATIONWIDE HEALTH PLANS
OH1528007002OtherNPI TYPE 1
OHCA4101131Medicare ID - Type Unspecified