Healthcare Provider Details

I. General information

NPI: 1467652321
Provider Name (Legal Business Name): RICHMOND FOOT AND ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5163 BELLE ISLE DR
DAYTON OH
45439-3229
US

IV. Provider business mailing address

1323 W 3RD ST
DAYTON OH
45402-6714
US

V. Phone/Fax

Practice location:
  • Phone: 937-829-1269
  • Fax:
Mailing address:
  • Phone: 937-461-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number59.000143
License Number StateOH

VIII. Authorized Official

Name: TANISHA RENNEE RICHMOND
Title or Position: PODIATRIST
Credential: DPM
Phone: 937-219-9831