Provider Demographics
NPI:1831160498
Name:MID-OHIO PODIATRY INC
Entity type:Organization
Organization Name:MID-OHIO PODIATRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-342-6351
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-5005
Mailing Address - Country:US
Mailing Address - Phone:419-342-6351
Mailing Address - Fax:419-347-1697
Practice Address - Street 1:110 W SMILEY AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875
Practice Address - Country:US
Practice Address - Phone:419-342-6351
Practice Address - Fax:419-347-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC14898OtherRAILROAD MEDICARE
OH0704956Medicaid
OH0718620001Medicare NSC
OH9228591Medicare PIN