Provider Demographics
NPI:1295157626
Name:FOUNDATION FOOT & ANKLE LLC
Entity type:Organization
Organization Name:FOUNDATION FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:SAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-364-7546
Mailing Address - Street 1:2620A N WOOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9461
Mailing Address - Country:US
Mailing Address - Phone:330-364-7546
Mailing Address - Fax:330-364-3720
Practice Address - Street 1:2620A N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9461
Practice Address - Country:US
Practice Address - Phone:330-364-7546
Practice Address - Fax:330-364-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003372213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099540Medicaid
OH0099540Medicaid