Provider Demographics
NPI:1700804648
Name:DAVIS FOOT & ANKLE SURGERY LLC
Entity Type:Organization
Organization Name:DAVIS FOOT & ANKLE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DPM
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-688-7764
Mailing Address - Street 1:3553 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4008
Mailing Address - Country:US
Mailing Address - Phone:330-688-7764
Mailing Address - Fax:330-688-7876
Practice Address - Street 1:3553 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4008
Practice Address - Country:US
Practice Address - Phone:330-688-7764
Practice Address - Fax:330-688-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003300D213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA9361171Medicare PIN
U94923Medicare UPIN
OHDA4104982Medicare PIN