Provider Demographics
NPI:1932285590
Name:MYERS PODIATRY LLC
Entity Type:Organization
Organization Name:MYERS PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-339-6233
Mailing Address - Street 1:515 UNION AVE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3004
Mailing Address - Country:US
Mailing Address - Phone:330-339-6233
Mailing Address - Fax:330-343-8460
Practice Address - Street 1:515 UNION AVE
Practice Address - Street 2:SUITE 147
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3004
Practice Address - Country:US
Practice Address - Phone:330-339-6233
Practice Address - Fax:330-343-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003164M213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2642519Medicaid
P00383430OtherRAILROAD MEDICARE
OH2642519Medicaid
OH9339963Medicare ID - Type Unspecified
P00383430OtherRAILROAD MEDICARE
OH9339962Medicare ID - Type Unspecified