Provider Demographics
NPI:1447301262
Name:SOUTHERN OHIO FOOT AND ANKLE ASSOCIATES INC
Entity type:Organization
Organization Name:SOUTHERN OHIO FOOT AND ANKLE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-775-7800
Mailing Address - Street 1:1130 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1174
Mailing Address - Country:US
Mailing Address - Phone:740-775-7800
Mailing Address - Fax:740-773-8545
Practice Address - Street 1:1130 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1174
Practice Address - Country:US
Practice Address - Phone:740-775-7800
Practice Address - Fax:740-773-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002135B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415032Medicaid
OH4769550001Medicare NSC
OH9310101Medicare PIN