MEDICARE: CIRCLEVILLE FOOT & ANKLE LLC

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	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DE4073	OTHER	OH	NEW RR MEDICARE C 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
2	5620650001	OTHER	OH	NEW DMERC C GROUP

General Provider Information

NPI Number	:	1205869377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLEVILLE FOOT & ANKLE LLC

Provider Business Mailing Address
First Line	:	210 SHARON RD
Second Line	:	P.O.BOX 865
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1498
Country	:	US
Telephone Number	:	740-474-3850
Fax Number	:	740-477-3440

Provider Business Practice Location Address
First Line	:	210 SHARON RD
Second Line	:	SUITE A
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1498
Country	:	US
Telephone Number	:	740-474-3850
Fax Number	:	740-477-3440

Authorized Official
Title or Position	:	PHYSICIAN - MEMBER
Name	:	BROCK A LIDEN
Credential	:	D.P.M.
Telephone Number	:	740-474-3850

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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Directions to “CIRCLEVILLE FOOT & ANKLE LLC ” Practice Location

Language	Start Address	Practice Location

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