Provider Demographics
NPI:1215128723
Name:JOHNNIE NINE TOES
Entity type:Organization
Organization Name:JOHNNIE NINE TOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PIACENTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-418-5668
Mailing Address - Street 1:1416 SHENANDOAH PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8137
Mailing Address - Country:US
Mailing Address - Phone:757-418-4556
Mailing Address - Fax:757-549-2004
Practice Address - Street 1:1416 SHENANDOAH PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8137
Practice Address - Country:US
Practice Address - Phone:757-418-4556
Practice Address - Fax:757-549-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180924OtherBLUE CROSS BLUE SHEILD
VAU45932Medicare UPIN
VA00W457J01Medicare PIN