Provider Demographics
NPI:1760497176
Name:FOOT AND ANKLE CENTERS OF OHIO, INC.
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTERS OF OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-492-9094
Mailing Address - Street 1:2097 W RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2447
Mailing Address - Country:US
Mailing Address - Phone:937-492-9094
Mailing Address - Fax:937-492-9478
Practice Address - Street 1:2097 W RUSSELL RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8683
Practice Address - Country:US
Practice Address - Phone:937-492-9094
Practice Address - Fax:934-492-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002287L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCJ0376OtherMEDICARE RAILROAD GROUP
OH0991646Medicaid
OH0991646Medicaid
OH0991646Medicaid