Provider Demographics
NPI:1912398132
Name:OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP,LLC
Entity Type:Organization
Organization Name:OHIO PODIATRIC PHYSICIANS AND SURGEONS GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-786-4482
Mailing Address - Street 1:8307 WINDHAM ST
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9406
Mailing Address - Country:US
Mailing Address - Phone:330-527-4088
Mailing Address - Fax:330-527-4089
Practice Address - Street 1:8307 WINDHAM ST
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9406
Practice Address - Country:US
Practice Address - Phone:330-527-4088
Practice Address - Fax:330-527-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003130213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1063817559OtherNPI