Healthcare Provider Details

I. General information

NPI: 1659364503
Provider Name (Legal Business Name): OHIO FOOT & ANKLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2217
US

IV. Provider business mailing address

350 W WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2217
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-8747
  • Fax: 614-895-8810
Mailing address:
  • Phone: 614-895-8747
  • Fax: 614-895-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS MASCIOLA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 614-895-8747