Provider Demographics
NPI:1861669970
Name:RICHMOND FOOT & ANKLE CLINIC, LLC
Entity Type:Organization
Organization Name:RICHMOND FOOT & ANKLE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-228-3668
Mailing Address - Street 1:1323 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6714
Mailing Address - Country:US
Mailing Address - Phone:937-228-3668
Mailing Address - Fax:937-228-3660
Practice Address - Street 1:1323 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6714
Practice Address - Country:US
Practice Address - Phone:937-228-3668
Practice Address - Fax:937-228-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003457213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH452898963002OtherMMOH
OH2841492Medicaid
OH000000571694OtherANTHEM
OH2796292Medicaid
OH452898963002OtherMMOH
OH2841492Medicaid
OH6152890001Medicare NSC
OH4227681Medicare PIN