Provider Demographics
NPI:1134398670
Name:COMPREHENSIVE PODIATRY LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-520-0033
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-520-0033
Mailing Address - Fax:216-707-3729
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-520-0033
Practice Address - Fax:216-707-3729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE PODIATRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003353332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4160321OtherPTAN
CO4160321OtherPTAN