GRAND LAKE PODIATRY INC NPI 1184896177

NPI Information

NPI: 1184896177
Provider Name: GRAND LAKE PODIATRY INC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
2624 LEXINGTON AVE
SPRINGFIELD, OH
ZIP 45505
Phone: (937) 322-3346
Get Directions

GRAND LAKE PODIATRY INC is a foot and ankle surgery podiatrist in Springfield, OH. GRAND LAKE PODIATRY INC NPI is 1184896177. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2624 LEXINGTON AVE
SPRINGFIELD, OH
ZIP 45505-607
Phone: (937) 322-3346
Fax: (937) 322-3348

The provider's authorized official is Mary Katherine Benjamin-swonger .
The authorized official title is Podiatrist/owner-president and has the following contact phone number (419) 586-7874.

The enumeration date for this NPI number is 3/31/2008 and was last updated on 6/9/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	36 002772	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	9285766	MEDICARE PIN	OHIO
2	2544885	MEDICAID	OHIO
3	1153470007	MEDICARE NSC
4	CG6681	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »