Provider Demographics
NPI:1205172780
Name:NORTHWEST FOOT & ANKLE, LLC
Entity type:Organization
Organization Name:NORTHWEST FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEBLASI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-204-6301
Mailing Address - Street 1:1930 CROWN PARK CT
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2402
Mailing Address - Country:US
Mailing Address - Phone:614-457-3212
Mailing Address - Fax:614-457-4052
Practice Address - Street 1:1930 CROWN PARK CT
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2402
Practice Address - Country:US
Practice Address - Phone:614-457-3212
Practice Address - Fax:614-457-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6719110001Medicare NSC