Provider Demographics
NPI:1669604047
Name:OFFUTT FOOT AND ANKLE INC
Entity type:Organization
Organization Name:OFFUTT FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OFFUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-965-3668
Mailing Address - Street 1:1380 CHESTER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1907
Mailing Address - Country:US
Mailing Address - Phone:765-965-3668
Mailing Address - Fax:
Practice Address - Street 1:1106 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5526
Practice Address - Country:US
Practice Address - Phone:765-965-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000991A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200958540Medicaid
IN07000991AOtherSTATE LICENSE
IN1700889102OtherDOCTORS INDIVIDUAL NPI NUMBER
IN1700889102OtherDOCTORS INDIVIDUAL NPI NUMBER
INBO9015682OtherFEDERAL DEA
IN07000991BOtherSTATE DEA
INBO9015682OtherFEDERAL DEA
IN262970Medicare PIN