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General NPI Number Information
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NPI Number | 1477715845
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY FOOT AND ANKLE CENTER INC
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 614 W LYTLE ST
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City | FOSTORIA
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State | OH
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Zip | 44830-3422
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Country | US
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Telephone | 419-435-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 614 W LYTLE ST
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City | FOSTORIA
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State | OH
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Zip | 44830-3422
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Country | US
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Telephone | 419-435-3554
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY D. KISTLER
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Credential | DPM
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Telephone | 419-435-3554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OH36003099
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | OH36003099
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License Number State | OH
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