Healthcare Provider Details

I. General information

NPI: 1316267693
Provider Name (Legal Business Name): PREMIER PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 CROWN PARK CT SUITE 120
COLUMBUS OH
43235-2402
US

IV. Provider business mailing address

1930 CROWN PARK CT SUITE 120
COLUMBUS OH
43235-2402
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-3212
  • Fax: 614-457-4052
Mailing address:
  • Phone: 614-457-3212
  • Fax: 614-457-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3609903368
License Number StateOH

VIII. Authorized Official

Name: MRS. DENA MERRIMAN
Title or Position: OWNER
Credential: D.P.M
Phone: 614-457-3212