Provider Demographics
NPI:1942424080
Name:FOOT AND ANKLE PHYSICIANS OF GEAUGA, INC.
Entity Type:Organization
Organization Name:FOOT AND ANKLE PHYSICIANS OF GEAUGA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-729-3668
Mailing Address - Street 1:12585 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2501
Mailing Address - Country:US
Mailing Address - Phone:440-729-3668
Mailing Address - Fax:440-729-9904
Practice Address - Street 1:12585 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2501
Practice Address - Country:US
Practice Address - Phone:440-729-3668
Practice Address - Fax:440-729-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2712213ES0103X
OH36-00-2717213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000168459OtherBLUE CROSS
OH2236959Medicaid
OH2236959Medicaid
OHU58694Medicare UPIN
OHU42018Medicare UPIN