Grand Lake Podiatry Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

36 002772 Issued in OH

Legal business name

GRAND LAKE PODIATRY INC

Practice address

2624 Lexington Ave
Springfield, OH 45505-2607

Phone

(937) 322-3346

Fax

(937) 322-3348

NPI assigned

Mar 31, 2008

Last updated

Jun 9, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Katherine Benjamin-Swonger, DPM

Title

Podiatrist/Owner-President

Phone

(419) 586-7874

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1184896177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 IRMSCHER BLVD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458228305",
            "telephone_number": "419-586-7874",
            "fax_number": "419-586-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 LEXINGTON AVE",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455052607",
            "telephone_number": "937-322-3346",
            "fax_number": "937-322-3348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE PODIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "BENJAMIN-SWONGER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "PODIATRIST/OWNER-PRESIDENT",
        "authorized_official_telephone_number": "419-586-7874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36 002772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2544885",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Springfield, OH
• Providers in Springfield, OH by specialty
• Foot & Ankle Surgery Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.