Provider Demographics
NPI:1194957993
Name:URBAN PODIATRY LLC
Entity type:Organization
Organization Name:URBAN PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BERTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-824-5336
Mailing Address - Street 1:4485 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2637
Mailing Address - Country:US
Mailing Address - Phone:614-824-5336
Mailing Address - Fax:614-732-4990
Practice Address - Street 1:4485 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2637
Practice Address - Country:US
Practice Address - Phone:614-824-5336
Practice Address - Fax:614-732-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003201213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3014946Medicaid
OH3014946Medicaid