MEDICARE: GENTLE FOOTCARE LLC

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		OH
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1396822698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE FOOTCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 27940
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-0940
Country	:	US
Telephone Number	:	614-239-9444
Fax Number	:	614-239-1080

Provider Business Practice Location Address
First Line	:	3663 RIDGE MILL DR STE 104
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-7799
Country	:	US
Telephone Number	:	614-529-7800
Fax Number	:	614-529-7800

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JEFFREY S WILSON
Credential	:	DPM
Telephone Number	:	614-239-9444

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/25/2023

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Directions to “GENTLE FOOTCARE LLC ” Practice Location

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