Provider Demographics
NPI:1841433703
Name:HOME VISIT PODIATRISTS, INC.
Entity type:Organization
Organization Name:HOME VISIT PODIATRISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-631-6016
Mailing Address - Street 1:2010 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3708
Mailing Address - Country:US
Mailing Address - Phone:513-631-6016
Mailing Address - Fax:513-631-2166
Practice Address - Street 1:2010 WAYLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3708
Practice Address - Country:US
Practice Address - Phone:513-631-6016
Practice Address - Fax:513-631-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9382291Medicare PIN
OH6236950001Medicare NSC