NPIMap

Organization Active NPI

Footsource MD, LLC

  • Customized Equipment (DME)
  • Westerville, OH
National Provider Identifier
1386807543
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
25-901188 Issued in OH
Legal business name
FOOTSOURCE MD, LLC
Practice address
300 Polaris Pkwy
Suite 2000
Westerville, OH 43082-7989
Phone
(614) 895-8747
Fax
(614) 882-6503
NPI assigned
Jul 8, 2008
Last updated
Dec 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Authorized official

Name
Dr. Thomas H Lee, MD
Title
President
Phone
(614) 895-8747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X 25-901188 OH Primary

Addresses

Primary practice location

300 Polaris Pkwy
Suite 2000
Westerville, OH 43082-7989

Mailing address

300 Polaris Pkwy
Suite 2000
Westerville, OH 43082-7989
Phone (614) 895-8747

National Provider Directory

National Provider Directory

Locations

300 Polaris Pkwy
Ste 2000
Westerville, OH 43082

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1386807543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 POLARIS PKWY",
            "address_2": "SUITE 2000",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827989",
            "telephone_number": "614-895-8747",
            "fax_number": "614-882-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 POLARIS PKWY",
            "address_2": "SUITE 2000",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827989",
            "telephone_number": "614-895-8747",
            "fax_number": "614-882-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTSOURCE MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-08",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-895-8747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "OH",
            "license": "25-901188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.