Provider Demographics
NPI:1699092171
Name:NORTHWOOD FOOT & ANKLE CENTER PC
Entity type:Organization
Organization Name:NORTHWOOD FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-393-8886
Mailing Address - Street 1:388 GARDEN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8998
Mailing Address - Country:US
Mailing Address - Phone:616-393-8886
Mailing Address - Fax:616-393-9975
Practice Address - Street 1:388 GARDEN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8998
Practice Address - Country:US
Practice Address - Phone:616-393-8886
Practice Address - Fax:616-393-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001739332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G00006OtherBLUE CROSS
MI3516763Medicaid
MIDP7405OtherRAILROAD MEDICARE
MI6298790001Medicare NSC
MIDP7405OtherRAILROAD MEDICARE
MI3516763Medicaid