Provider Demographics
NPI:1295885697
Name:FOOT & ANKLE SPECIALISTS INC
Entity type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-432-6556
Mailing Address - Street 1:123 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2325
Mailing Address - Country:US
Mailing Address - Phone:740-432-6556
Mailing Address - Fax:740-432-2506
Practice Address - Street 1:123 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2325
Practice Address - Country:US
Practice Address - Phone:740-432-6556
Practice Address - Fax:740-432-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9290002Medicare PIN
4851180001Medicare NSC
EL0484535Medicare PIN
EL0484534Medicare PIN
9290001Medicare PIN