Provider Demographics
NPI:1356748313
Name:WORTHINGTON FOOT & ANKLE, LLC
Entity type:Organization
Organization Name:WORTHINGTON FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAUVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-357-8418
Mailing Address - Street 1:37 E WILSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2354
Mailing Address - Country:US
Mailing Address - Phone:614-905-6342
Mailing Address - Fax:
Practice Address - Street 1:7620 OLENTANGY RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1363
Practice Address - Country:US
Practice Address - Phone:614-905-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003681213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023345956OtherNPI INDIVIDUAL
1962715722OtherNPI INDIVIDUAL
OH7313220001Medicare NSC