Provider Demographics
NPI:1689855686
Name:RICHMOND PODIATRY, P.C.
Entity Type:Organization
Organization Name:RICHMOND PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:WEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-962-3724
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-0396
Mailing Address - Country:US
Mailing Address - Phone:765-962-3724
Mailing Address - Fax:
Practice Address - Street 1:1201 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5623
Practice Address - Country:US
Practice Address - Phone:765-962-3724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000578213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INWE-094780OtherMEDICARE ID
INT77197Medicare UPIN
4419100001Medicare NSC