Provider Demographics
NPI:1821522103
Name:FOOT & ANKLE INSTITUTE, INC
Entity Type:Organization
Organization Name:FOOT & ANKLE INSTITUTE, INC
Other - Org Name:DR. JON OLIVERIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-825-7878
Mailing Address - Street 1:1193 NORTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9516
Mailing Address - Country:US
Mailing Address - Phone:330-825-7878
Mailing Address - Fax:330-595-4729
Practice Address - Street 1:1193 NORTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9516
Practice Address - Country:US
Practice Address - Phone:330-825-7878
Practice Address - Fax:330-595-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002891213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156343Medicaid
OH0156343Medicaid