MEDICARE: WADSWORTH 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	213ES0103X	Foot & Ankle Surgery Podiatrist	36003282	OH

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	000000329689	OTHER	OH	ANTHEM
3	240517	OTHER	OH	CIGNA
4	106409	OTHER	OH	NATIONWIDE HEALTH PLANS
5	5127460001	OTHER	OH	ADMIN FED
6	1528007002	OTHER	OH	NPI TYPE 1

General Provider Information

NPI Number	:	1669502670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WADSWORTH FOOT & ANKLE, LLC

Provider Business Mailing Address
First Line	:	229 LEATHERMAN RD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9236
Country	:	US
Telephone Number	:	330-336-7075
Fax Number	:	330-336-4211

Provider Business Practice Location Address
First Line	:	229 LEATHERMAN RD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9236
Country	:	US
Telephone Number	:	330-336-7075
Fax Number	:	330-336-4211

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK ANTHONY CAMPBELL
Credential	:	D.P.M.
Telephone Number	:	330-336-7075

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	05/08/2008

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Directions to “WADSWORTH FOOT & ANKLE, LLC ” Practice Location

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