Provider Demographics
NPI:1831365238
Name:ALLIED PODIATRY, INC
Entity type:Organization
Organization Name:ALLIED PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-763-1035
Mailing Address - Street 1:1400 S MAIN ST
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1581
Mailing Address - Country:US
Mailing Address - Phone:419-763-1035
Mailing Address - Fax:419-763-1128
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:SUITES A & B
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1581
Practice Address - Country:US
Practice Address - Phone:419-763-1035
Practice Address - Fax:419-763-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003384213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDN5965OtherRAILROAD
OH2917295Medicaid
OHDN5965OtherRAILROAD
OH6131660001Medicare NSC
OH2917295Medicaid