Provider Demographics
NPI:1205901105
Name:FOOT AND ANKLE INSTITUTE, INC
Entity type:Organization
Organization Name:FOOT AND ANKLE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLIVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-825-7878
Mailing Address - Street 1:1193 NORTON AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9526
Mailing Address - Country:US
Mailing Address - Phone:330-825-7878
Mailing Address - Fax:330-595-4729
Practice Address - Street 1:1193 NORTON AVENUE
Practice Address - Street 2:UNIT D
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9516
Practice Address - Country:US
Practice Address - Phone:330-825-7878
Practice Address - Fax:330-658-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002891213E00000X, 225100000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2755700Medicaid
OH1101090002Medicare NSC
OH2755700Medicaid
1101090002Medicare NSC
OHDG3391Medicare PIN
OH9367622Medicare PIN
056409Medicare UPIN