Provider Demographics
NPI:1528164837
Name:WILMINGTON FOOT AND ANKLE INC
Entity type:Organization
Organization Name:WILMINGTON FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-383-2311
Mailing Address - Street 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2171
Mailing Address - Country:US
Mailing Address - Phone:937-383-2311
Mailing Address - Fax:937-383-3485
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2170
Practice Address - Country:US
Practice Address - Phone:937-383-2311
Practice Address - Fax:937-383-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002755213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0878886Medicaid
OH480015839OtherRAILROAD
OH0499570001Medicare NSC
WI9273531Medicare PIN