MEDICARE: FOOT AND ANKLE CENTERS OF OHIO, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	36003384	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CJ0376	OTHER	OH	MEDICARE RAILROAD GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174574354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE CENTERS OF OHIO, INC.

Provider Business Mailing Address
First Line	:	1013 E SPRING ST
Second Line	:
City	:	ST MARYS
State	:	OH
Zip	:	45885-2447
Country	:	US
Telephone Number	:	419-394-8664
Fax Number	:	419-394-1148

Provider Business Practice Location Address
First Line	:	1013 E SPRING ST
Second Line	:
City	:	ST MARYS
State	:	OH
Zip	:	45885-2447
Country	:	US
Telephone Number	:	419-394-8664
Fax Number	:	419-394-1148

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUGENE R LITTLE JR.
Credential	:	DPM
Telephone Number	:	419-394-8664

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	12/18/2012

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Directions to “FOOT AND ANKLE CENTERS OF OHIO, INC. ” Practice Location

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