Provider Demographics
NPI:1215345020
Name:DR. JAMES BANGAYAN FOOT & ANKLE SPECIALTY INC.
Entity type:Organization
Organization Name:DR. JAMES BANGAYAN FOOT & ANKLE SPECIALTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BANGAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-842-6781
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-565-7294
Mailing Address - Fax:440-842-6781
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 309
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-565-7294
Practice Address - Fax:440-842-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003437332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3143208Medicaid
6486840002Medicare NSC
OH9391791Medicare PIN
V09774Medicare UPIN
6486840003Medicare NSC