Provider Demographics
NPI:1255709440
Name:ASHLAND/MANSFIELD FOOT & ANKLE SPECIALISTS
Entity type:Organization
Organization Name:ASHLAND/MANSFIELD FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-281-3668
Mailing Address - Street 1:45 AMBERWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9765
Mailing Address - Country:US
Mailing Address - Phone:419-281-3668
Mailing Address - Fax:419-281-4219
Practice Address - Street 1:45 AMBERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-9765
Practice Address - Country:US
Practice Address - Phone:419-281-3668
Practice Address - Fax:419-281-4219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLAND/MANSFIELD FOOT & ANKLE SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003040213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty