Provider Demographics
NPI:1871779850
Name:SWISS VALLEY FOOT & ANKLE CENTER
Entity type:Organization
Organization Name:SWISS VALLEY FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-472-2259
Mailing Address - Street 1:832 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-9423
Mailing Address - Country:US
Mailing Address - Phone:740-472-2259
Mailing Address - Fax:
Practice Address - Street 1:832 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-9423
Practice Address - Country:US
Practice Address - Phone:740-472-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4600520001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2328243Medicaid
OHSP03821Medicare PIN
OHU90140Medicare UPIN
OH2328243Medicaid