Healthcare Provider Details

I. General information

NPI: 1861669970
Provider Name (Legal Business Name): RICHMOND FOOT & ANKLE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 3RD ST
DAYTON OH
45402-6714
US

IV. Provider business mailing address

1323 W 3RD ST
DAYTON OH
45402-6714
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-3668
  • Fax: 937-228-3660
Mailing address:
  • Phone: 937-228-3668
  • Fax: 937-228-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003457
License Number StateOH

VIII. Authorized Official

Name: DR. TANISHA R. RICHMOND
Title or Position: OWNER
Credential:
Phone: 937-228-3668