Provider Demographics
NPI:1831360262
Name:HARBOURTOWN FOOT & ANKLE CLINIC, INC.
Entity type:Organization
Organization Name:HARBOURTOWN FOOT & ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:CYNTHIA
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-967-7498
Mailing Address - Street 1:5435 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1333
Mailing Address - Country:US
Mailing Address - Phone:440-967-7498
Mailing Address - Fax:
Practice Address - Street 1:5435 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1333
Practice Address - Country:US
Practice Address - Phone:440-967-7498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003187B213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187100Medicaid
OHU79991Medicare UPIN
OH2187100Medicaid
OHHA4043621Medicare PIN