Healthcare Provider Details

I. General information

NPI: 1477715845
Provider Name (Legal Business Name): TRI-COUNTY FOOT AND ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W LYTLE ST
FOSTORIA OH
44830-3422
US

IV. Provider business mailing address

614 W LYTLE ST
FOSTORIA OH
44830-3422
US

V. Phone/Fax

Practice location:
  • Phone: 419-435-3554
  • Fax:
Mailing address:
  • Phone: 419-435-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberOH36003099
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOH36003099
License Number StateOH

VIII. Authorized Official

Name: MR. TIMOTHY D. KISTLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 419-435-3554