=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881600617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PODIATRIC HEALTH PHYSICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 05/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 365 RIFFEL RD SUITE A
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-8592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-364-7546
-----------------------------------------------------
Fax | 330-364-3720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 RIFFEL RD SUITE A
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-8592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-364-7546
-----------------------------------------------------
Fax | 330-364-3720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD A RANSOM
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 330-364-7546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 1623
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------