MEDICARE: PREMIER FOOT & ANKLE CARE 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

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

General Provider Information

NPI Number	:	1720747827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER FOOT & ANKLE CARE LLC

Provider Business Mailing Address
First Line	:	8350 ESQUIRE ST NW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-8721
Country	:	US
Telephone Number	:	330-899-1051
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 GREENWICH RD
Second Line	:
City	:	NORTON
State	:	OH
Zip	:	44203-5780
Country	:	US
Telephone Number	:	330-899-1051
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBERLY S. KEMPER
Credential	:	DPM
Telephone Number	:	330-899-1051

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	03/28/2024

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