Provider Demographics
NPI:1285881128
Name:ANKLE AND FOOT SPECIALISTS OF MARION, INC
Entity type:Organization
Organization Name:ANKLE AND FOOT SPECIALISTS OF MARION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-383-5115
Mailing Address - Street 1:1051 HARDING MEMORIAL PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6347
Mailing Address - Country:US
Mailing Address - Phone:740-383-5115
Mailing Address - Fax:740-387-3668
Practice Address - Street 1:1051 HARDING MEMORIAL PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6347
Practice Address - Country:US
Practice Address - Phone:740-383-5115
Practice Address - Fax:740-387-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2003213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0481447Medicaid
OH0481447Medicaid
BR0508231Medicare PIN
OH6180380001Medicare NSC