Provider Demographics
NPI:1184782690
Name:FOOT SPECIALISTS OF GREATER CINCINNATI
Entity type:Organization
Organization Name:FOOT SPECIALISTS OF GREATER CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-341-9900
Mailing Address - Street 1:2865 CHANCELLOR DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:859-341-9900
Mailing Address - Fax:859-341-1649
Practice Address - Street 1:238 BARNES ROAD
Practice Address - Street 2:ST ELIZABETH GRANT COUNTY
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097
Practice Address - Country:US
Practice Address - Phone:859-341-9900
Practice Address - Fax:859-341-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6198OtherADMINASTAR
KY8090004Medicaid
8787OtherADMINASTAR
2440449000OtherPASSPORT ADVANTAGE
8789OtherADMINASTAR
4111020001OtherPALMETTO
1169438OtherPASSPORT HEALTH
4111020003OtherPALMETTO
8788OtherADMINASTAR
=========002OtherTRICARE
1169438OtherPASSPORT HEALTH
8788OtherADMINASTAR