Provider Demographics
NPI:1922526698
Name:FOOT AND ANKLE PHYSICIANS OF OHIO, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE PHYSICIANS OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NITTALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-461-8154
Mailing Address - Street 1:1325 STRINGTOWN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9288
Mailing Address - Country:US
Mailing Address - Phone:614-461-8154
Mailing Address - Fax:614-461-7136
Practice Address - Street 1:1325 STRINGTOWN RD STE 220
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8911
Practice Address - Country:US
Practice Address - Phone:614-782-3668
Practice Address - Fax:614-782-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003510213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0753340Medicaid