Provider Demographics
NPI:1194910901
Name:OHIO FOOT CARE INC.
Entity type:Organization
Organization Name:OHIO FOOT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VACHERESSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-901-0000
Mailing Address - Street 1:855 W COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9587
Mailing Address - Country:US
Mailing Address - Phone:614-901-0000
Mailing Address - Fax:614-901-4117
Practice Address - Street 1:2525 TILLER LN
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2267
Practice Address - Country:US
Practice Address - Phone:614-901-0000
Practice Address - Fax:614-901-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2944201Medicaid
OH2305991Medicaid
OHDF0051OtherRAILROAD MEDICARE
OH2305991Medicaid
OH2944201Medicaid
OHU88604Medicare UPIN