Healthcare Provider Details

I. General information

NPI: 1649437872
Provider Name (Legal Business Name): COSHOCTON COUNTY FOOT & ANKLE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FAIRY FALLS DR SUITE 5
COSHOCTON OH
43812-2803
US

IV. Provider business mailing address

1100 FAIRY FALLS DR SUITE 5
COSHOCTON OH
43812-2803
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0338
  • Fax: 888-730-2212
Mailing address:
  • Phone: 740-622-0338
  • Fax: 888-730-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2656
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2656
License Number StateOH

VIII. Authorized Official

Name: MRS. KATIE L LITSEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 740-622-0338