Provider Demographics
NPI:1023250248
Name:PODIATRY HOME HEALTH CARE
Entity type:Organization
Organization Name:PODIATRY HOME HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-885-2130
Mailing Address - Street 1:5683 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2528
Mailing Address - Country:US
Mailing Address - Phone:440-885-2130
Mailing Address - Fax:440-848-8406
Practice Address - Street 1:5683 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2528
Practice Address - Country:US
Practice Address - Phone:440-885-2130
Practice Address - Fax:440-848-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003284213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2323444Medicaid
OHU89457Medicare UPIN
OH2323444Medicaid
OHWE4071941Medicare Oscar/Certification