Provider Demographics
NPI:1992985907
Name:NORTHEASTERN OHIO FOOT AND ANKLE INC
Entity type:Organization
Organization Name:NORTHEASTERN OHIO FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-856-4444
Mailing Address - Street 1:8588 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2339
Mailing Address - Country:US
Mailing Address - Phone:330-856-4444
Mailing Address - Fax:
Practice Address - Street 1:8588 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2339
Practice Address - Country:US
Practice Address - Phone:330-856-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002617213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2308667Medicaid
OH2319093Medicaid
OH2319128Medicaid
OH2319100Medicaid
OHDA3791Medicare PIN
OH2308667Medicaid
OH5237700001Medicare NSC
OH9321855Medicare PIN
OH2319093Medicaid