Provider Demographics
NPI:1457512949
Name:STARK COUNTY FOOT & ANKLE CLINIC
Entity type:Organization
Organization Name:STARK COUNTY FOOT & ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-837-7715
Mailing Address - Street 1:4503 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2331
Mailing Address - Country:US
Mailing Address - Phone:330-956-4857
Mailing Address - Fax:
Practice Address - Street 1:4503 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2331
Practice Address - Country:US
Practice Address - Phone:330-956-4857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH36002987213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9377401Medicare PIN
OH6203350001Medicare NSC