MEDICARE: OHIO FOOT CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36003295	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DF0051	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194910901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO FOOT CARE INC.

Provider Business Mailing Address
First Line	:	855 W COSHOCTON ST
Second Line	:
City	:	JOHNSTOWN
State	:	OH
Zip	:	43031-9587
Country	:	US
Telephone Number	:	614-901-0000
Fax Number	:	614-901-4117

Provider Business Practice Location Address
First Line	:	2525 TILLER LN
Second Line	:	SUITE 105
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2267
Country	:	US
Telephone Number	:	614-901-0000
Fax Number	:	614-901-4117

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THERESA LYNN VACHERESSE
Credential	:	DPM
Telephone Number	:	614-901-0000

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	12/29/2011

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Directions to “OHIO FOOT CARE INC. ” Practice Location

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