NPIMap

Organization Active NPI

Grand Lake Foot & Ankle Inc

  • Podiatrist
  • Celina, OH
National Provider Identifier
1841576998
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36002772 Issued in OH
Legal business name
GRAND LAKE FOOT & ANKLE INC
Practice address
1222 Irmscher Blvd
Celina, OH 45822-8305
Phone
(419) 586-7874
Fax
(419) 586-2776
NPI assigned
Nov 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Authorized official

Name
Mary Benjamin Swonger, DPM
Title
DPM
Phone
(419) 586-7874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 36002772 OH Primary

Addresses

Primary practice location

1222 Irmscher Blvd
Celina, OH 45822-8305

Mailing address

1222 Irmscher Blvd
Celina, OH 45822-8305
Phone (419) 586-7874

Other identifiers 1

IdentifierTypeStateIssuer
0061420MedicaidOH

National Provider Directory

National Provider Directory

Locations

1222 Irmscher Blvd
Celina, OH 45822
Phone (419) 586-7874

NPI Registry JSON

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1841576998",
    "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": "1222 IRMSCHER BLVD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458228305",
            "telephone_number": "419-586-7874",
            "fax_number": "419-586-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE FOOT & ANKLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "BENJAMIN SWONGER",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "419-586-7874",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36002772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0061420",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Celina, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.