Provider Demographics
NPI:1740215706
Name:CENTRAL OHIO COMPREHENSIVE FOOT CARE LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO COMPREHENSIVE FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-891-2828
Mailing Address - Street 1:575 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8977
Mailing Address - Country:US
Mailing Address - Phone:614-891-2828
Mailing Address - Fax:614-891-5411
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:SUITE 2F
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-891-2828
Practice Address - Fax:614-891-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002387213E00000X
OH36002522213E00000X
213E00000X, 213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH9649OtherRAILROAD MEDICARE
OH2693287Medicaid
OH3117953500A00OtherANTHEM
OHCH9649OtherRAILROAD MEDICARE
OH2693287Medicaid