Provider Demographics
NPI:1285093625
Name:HILLIARD FAMILY PODIATRY, LLC.
Entity type:Organization
Organization Name:HILLIARD FAMILY PODIATRY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DP,M
Authorized Official - Phone:614-636-3668
Mailing Address - Street 1:5539 HILLIARD ROME OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7287
Mailing Address - Country:US
Mailing Address - Phone:614-636-3668
Mailing Address - Fax:614-363-4723
Practice Address - Street 1:5539 HILLIARD ROME OFFICE PARK
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7287
Practice Address - Country:US
Practice Address - Phone:614-636-3668
Practice Address - Fax:614-363-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-13
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003541213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7536600001Medicare NSC