MEDICARE: PREMIER PODIATRY

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	213ES0131X	Foot Surgery Podiatrist	3609903368	OH

General Provider Information

NPI Number	:	1316267693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PODIATRY

Provider Business Mailing Address
First Line	:	1930 CROWN PARK CT
Second Line	:	SUITE 120
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2402
Country	:	US
Telephone Number	:	614-457-3212
Fax Number	:	614-457-4052

Provider Business Practice Location Address
First Line	:	1930 CROWN PARK CT
Second Line	:	SUITE 120
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2402
Country	:	US
Telephone Number	:	614-457-3212
Fax Number	:	614-457-4052

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DENA MERRIMAN
Credential	:	D.P.M
Telephone Number	:	614-457-3212

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	12/20/2010

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Practice Location Address:

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1205172780 — NORTHWEST FOOT & ANKLE, LLC
Practice Location Address:

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1386044618 — MRS. KEILAH SHUMAKER ED.S.
Practice Location Address:

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1003294539 — ADVANCED ANKLE AND FOOT CENTER, LLC
Practice Location Address:

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Directions to “PREMIER PODIATRY ” Practice Location

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