Provider Demographics
NPI:1174617989
Name:PODIATRY ASSOCIATES OF CINCINNATI, INC
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF CINCINNATI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-474-4450
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-0418
Mailing Address - Country:US
Mailing Address - Phone:513-474-1906
Mailing Address - Fax:513-474-9272
Practice Address - Street 1:7690 DISCOVERY DRIVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-474-4450
Practice Address - Fax:513-474-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2736570Medicaid
OH000000251377OtherANTHEM