MEDICARE: FOOT AND ANKLE SPECIALISTS OF CENTRAL OHIO 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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1548831977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE SPECIALISTS OF CENTRAL OHIO LLC

Provider Business Mailing Address
First Line	:	426 BEECHER RD STE A
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-3506
Country	:	US
Telephone Number	:	614-939-9330
Fax Number	:	614-939-9299

Provider Business Practice Location Address
First Line	:	3192 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1945
Country	:	US
Telephone Number	:	614-235-2323
Fax Number	:	614-235-0092

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SCOTT GURWIN
Credential	:
Telephone Number	:	740-344-8286

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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