GRAND LAKE PODIATRY INC NPI 1871765362

NPI Information

NPI: 1871765362
Provider Name: GRAND LAKE PODIATRY INC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
1222 IRMSCHER BLVD
CELINA, OH
ZIP 45822
Phone: (419) 586-7874
Get Directions

GRAND LAKE PODIATRY INC is a foot and ankle surgery podiatrist in Celina, OH. GRAND LAKE PODIATRY INC NPI is 1871765362. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1222 IRMSCHER BLVD
CELINA, OH
ZIP 45822-305
Phone: (419) 586-7874
Fax: (419) 586-2776

The provider's authorized official is Mary Katherine Swonger .
The authorized official title is Podiatrist/owner-president and has the following contact phone number 41958687874.

The enumeration date for this NPI number is 3/25/2008 and was last updated on 6/14/2011.

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	2056313	MEDICAID	OHIO
2	1153470001	MEDICARE NSC
3	9285762	MEDICARE PIN	OHIO
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: 4/28/2024

NPI Synchronization or Removal

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