Provider Demographics
NPI:1578865531
Name:COMPLETE FOOT AND ANKLE CARE
Entity type:Organization
Organization Name:COMPLETE FOOT AND ANKLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-737-7016
Mailing Address - Street 1:401 MARKET ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2881
Mailing Address - Country:US
Mailing Address - Phone:740-282-0861
Mailing Address - Fax:740-282-7002
Practice Address - Street 1:401 MARKET ST
Practice Address - Street 2:SUITE 802
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2881
Practice Address - Country:US
Practice Address - Phone:740-282-0861
Practice Address - Fax:740-282-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003211213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3138170Medicaid
1285657460OtherINDIVIDUAL NPI
OH4095901Medicare PIN