Provider Demographics
NPI:1215512157
Name:ON THE GO TOES INC
Entity type:Organization
Organization Name:ON THE GO TOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-200-8814
Mailing Address - Street 1:65 LINCOLN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-1608
Mailing Address - Country:US
Mailing Address - Phone:207-200-8814
Mailing Address - Fax:207-558-8980
Practice Address - Street 1:65 LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-1608
Practice Address - Country:US
Practice Address - Phone:207-200-8814
Practice Address - Fax:207-558-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty