Provider Demographics
NPI:1528498417
Name:ANKLE AND FOOT CARE CENTERS
Entity type:Organization
Organization Name:ANKLE AND FOOT CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-629-8800
Mailing Address - Street 1:163 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44003-9319
Mailing Address - Country:US
Mailing Address - Phone:440-293-6765
Mailing Address - Fax:
Practice Address - Street 1:163 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9319
Practice Address - Country:US
Practice Address - Phone:440-293-6765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9270991Medicare PIN
OH0996920025Medicare NSC