Provider Demographics
NPI:1134248172
Name:PODIATRY ASSOCIATES OF LAKE COUNTY, INC.
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF LAKE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-352-2201
Mailing Address - Street 1:161 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3449
Mailing Address - Country:US
Mailing Address - Phone:440-352-2201
Mailing Address - Fax:440-352-0242
Practice Address - Street 1:161 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3449
Practice Address - Country:US
Practice Address - Phone:440-352-2201
Practice Address - Fax:440-352-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822015Medicaid
OH9933871Medicare PIN
OH0640030001Medicare NSC
OHCM958Medicare PIN