Provider Demographics
NPI:1710033535
Name:CENTRAL OHIO PODIATRY GROUP INC
Entity Type:Organization
Organization Name:CENTRAL OHIO PODIATRY GROUP INC
Other - Org Name:CENTRAL OHIO PODIATRY GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-890-7224
Mailing Address - Street 1:550 S CLEVELAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8958
Mailing Address - Country:US
Mailing Address - Phone:614-890-7224
Mailing Address - Fax:614-890-8253
Practice Address - Street 1:550 S CLEVELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8958
Practice Address - Country:US
Practice Address - Phone:614-890-7224
Practice Address - Fax:614-923-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721035Medicaid
OH0572090001Medicare PIN
OHP00139967Medicare PIN
OH9927722Medicare PIN
OH9927723Medicare PIN
OH0572090001Medicare NSC
OH9927721Medicare PIN