Healthcare Provider Details

I. General information

NPI: 1346644200
Provider Name (Legal Business Name): FOOT AND ANKLE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 W CENTRAL AVE
SPRINGBORO OH
45066-3020
US

IV. Provider business mailing address

766 W CENTRAL AVE
SPRINGBORO OH
45066-3020
US

V. Phone/Fax

Practice location:
  • Phone: 937-746-0586
  • Fax:
Mailing address:
  • Phone: 937-746-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LAURENCE FRANK
Title or Position: PRESIDENT
Credential: DPM
Phone: 937-746-0586