Provider Demographics
NPI:1356412142
Name:AUSTINTOWN PODIATRY ASSOCIATES INC
Entity type:Organization
Organization Name:AUSTINTOWN PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-792-6519
Mailing Address - Street 1:1300 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4081
Mailing Address - Country:US
Mailing Address - Phone:330-792-6519
Mailing Address - Fax:330-792-9911
Practice Address - Street 1:1300 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4081
Practice Address - Country:US
Practice Address - Phone:330-792-6519
Practice Address - Fax:330-792-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3600-2881213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1953345OtherHIGHMARK BCBS PA
OH0835949Medicaid
PA1953345OtherHIGHMARK BCBS PA
OH0835949Medicaid
OH9278003Medicare PIN
OH9278001Medicare PIN
OH9278002Medicare PIN
PA056971Medicare PIN