GRAND LAKE PODIATRY, INC (NPI# 1538331525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538331525 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE PODIATRY, INC |
| Practice Address |
812 Redskin Trl Ste B Wapakoneta OH 45895-8545 |
| Mailing Address |
1222 Irmscher Blvd Celina OH 45822-8305 |
| Practice Telephone | 4195867874 |
| Practice Fax Number | 4195862776 |
| Mailing Telephone | 4195867874 |
| Mailing Fax Number | 4165862776 |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-04-18 |
| Authorized Official Name | DR. MARY KATHERINE BENJAMIN-SWONGER (PODIATRIST/OWNER-PRESIDENT) |
| Authorized Official Telephone | 4195867874 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
36 002772 | OH | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2544901 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164694428 | Grand Lake Podiatry, Inc | Podiatrist | 6 Eagle Dr, Minster, OH 45865-9714 | 2008-03-27 |
| Street Address |
812 REDSKIN TRL STE B |
| City | WAPAKONETA |
| State | OH |
| Zip Code | 45895-8545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750334678 | Joint Township District Memorial Hospital | General Practice | 812 Redskin Trl, Wapakoneta, OH 45895-8545 | 2006-05-19 |
| 1356772255 | Jtdm Family Practice LLC | Family Medicine | 812 Redskin Trl, Wapakoneta, OH 45895-8545 | 2013-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558834119 | Dr Eric West Dc Inc | Chiropractor | 801 Brewfield Redskin Trail, Wapakoneta, OH 45895 | 2019-01-07 |
| 1063931624 | Teresa Howell | Home Health | 15500 Bay Road, Wapakoneta, OH 45895 | 2017-09-14 |
| 1891241410 | Dion Michael Paul | Occupational Therapy Assistant | 305 East Mechanic St., Wapakoneta, OH 45895 | 2016-09-01 |
| 1609235480 | Marianne Morrisey | Speech-Language Pathologist | 1010 Lincoln Ave, Wapakoneta, OH 45895 | 2016-02-22 |
| 1700285327 | Brittany Kay Clark | Nurse Practitioner | 1258 Bellefontaine St Ste A, Wapakoneta, OH 45895 | 2014-08-19 |
| 1871896621 | Barbara Jill Cummins | Family Medicine | 807 Glynwood Road, Wapakoneta, OH 45895 | 2010-12-17 |
| 1649410630 | Michael Justin Nagel | Chiropractor | 801 Brewfield Dr., Redskin Trail, Wapakoneta, OH 45895 | 2009-03-03 |
| 1538331475 | Alliance for Women's Health Inc | Obstetrics & Gynecology | 1251 Lincoln Avenue, Wapakoneta, OH 45895 | 2008-04-01 |
| 1275745754 | New Vision Nursing and Home Care LLC | Home Health | 310 Perry St, Wapakoneta, OH 45895 | 2007-05-04 |
| 1346461886 | Rudolph Lewis Vostatek | Dentist | 1101 Defiance Street, Wapakoneta, OH 45895 | 2007-05-01 |
| Find all providers in zip 45895 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992321228 | Mary Matta | Podiatrist | 425 West Fith Street, East Liverpool, OH 43920 | 2020-06-23 |
| 1063047942 | Jennifer C. Swan, Dpm, LLC | Podiatrist | 155 Commerce Park Dr Ste 7, Westerville, OH 43082-8384 | 2020-03-11 |
| 1518599117 | Howard Waxman | Podiatrist | 35000 Chardon Rd Ste 220, Willoughby Hills, OH 44094-9019 | 2020-02-11 |
| 1346887510 | Performance Foot and Ankle, LLC | Podiatrist | 3727 Friendsville Rd Unit 2, Wooster, OH 44691-7127 | 2019-12-05 |
| 1053971200 | Lauren Digregorio Dpm | Podiatrist | 1502 Lear Industrial Pkwy Ste 1a, Avon, OH 44011-1380 | 2019-06-19 |
| 1477117331 | North Eastern Ohio Podiatry Group LLC | Podiatrist | 4200 Warrensville Center Road, Suite 271, Warrensville Heights, OH 44122-6805 | 2019-04-26 |
| 1336611672 | Anthony G Polito Dpm Inc | Podiatrist | 4071 N Jefferson St, Medina, OH 44256-5622 | 2018-12-27 |
| 1023547957 | Phuoc Bui | Podiatrist | 4260 Glendale Mildford Rd. Ste 103, Blue Ash, OH 45242 | 2017-06-05 |
| 1639606619 | David Mathew Bishop | Podiatrist | 200 East State St, Alliance Community Hospital, Alliance, OH 44601 | 2017-05-22 |
| 1174058630 | Lance Jon Johnson | Podiatrist | 1400 W Main St Bldg 1, Suite A, Bellevue, OH 44811-9429 | 2017-04-21 |
| Find all providers with the same taxonomy | ||||
| City | WAPAKONETA |
| Zip Code | 45895 |
Please comment or provide details below to improve the information on GRAND LAKE PODIATRY, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.