Healthcare Provider Details

I. General information

NPI: 1609951482
Provider Name (Legal Business Name): TRI COUNTY FOOT AND ANKLE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DR MIKE CLOUSE DRIVE
SOMERSET OH
43783
US

IV. Provider business mailing address

3777 JAMES CT
ZANESVILLE OH
43701-8127
US

V. Phone/Fax

Practice location:
  • Phone: 740-450-3294
  • Fax: 740-450-3295
Mailing address:
  • Phone: 740-450-3294
  • Fax: 740-450-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003086
License Number StateOH

VIII. Authorized Official

Name: MARK W SCOTT
Title or Position: PRESIDENT
Credential: DPM
Phone: 740-450-3294