Provider Demographics
NPI:1588697767
Name:DELAWARE PODIATRY CENTER LLC
Entity type:Organization
Organization Name:DELAWARE PODIATRY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-369-3071
Mailing Address - Street 1:575 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8977
Mailing Address - Country:US
Mailing Address - Phone:614-891-2828
Mailing Address - Fax:614-891-5411
Practice Address - Street 1:357 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1476
Practice Address - Country:US
Practice Address - Phone:740-369-3071
Practice Address - Fax:740-369-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002522213E00000X
OH36003279213E00000X
OH36002387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437867Medicaid
OH030507736A11OtherANTHEM
OH4778110001OtherADMINASTAR
OHDA5911OtherRAILROAD MEDICARE
OH2437867Medicaid