Healthcare Provider Details

I. General information

NPI: 1164760765
Provider Name (Legal Business Name): COMPLETE FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 E HIGH ST STE B
SPRINGFIELD OH
45505-1371
US

IV. Provider business mailing address

1400 S MAIN ST
BELLEFONTAINE OH
43311-1581
US

V. Phone/Fax

Practice location:
  • Phone: 937-322-3346
  • Fax: 937-599-4852
Mailing address:
  • Phone: 937-599-3668
  • Fax: 937-599-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD F JENNINGS
Title or Position: OWNER/PHYSICIAN
Credential: D.P.M.
Phone: 614-893-6942