Provider Demographics
NPI:1063719698
Name:FOOT & ANKLE HEALTH SPECIALTIES
Entity type:Organization
Organization Name:FOOT & ANKLE HEALTH SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:614-493-6535
Mailing Address - Street 1:6336 BLUE HERON LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6434
Mailing Address - Country:US
Mailing Address - Phone:614-493-6535
Mailing Address - Fax:
Practice Address - Street 1:6336 BLUE HERON LANE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6434
Practice Address - Country:US
Practice Address - Phone:614-493-6535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003256213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty