NPIMap

Organization Active NPI

Grand Lake Podiatry Inc

  • Foot & Ankle Surgery Podiatrist
  • Celina, OH
National Provider Identifier
1871765362
Registry record updated Jun 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
36 002772 Issued in OH
Legal business name
GRAND LAKE PODIATRY INC
Practice address
1222 Irmscher Blvd
Celina, OH 45822-8305
Phone
(419) 586-7874
Fax
(419) 586-2776
NPI assigned
Mar 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2011

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

Authorized official

Name
Dr. Mary Katherine Swonger, DPM
Title
Podiatrist/Owner-President
Phone
41958687874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 36 002772 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
2056313MedicaidOH

National Provider Directory

National Provider Directory

Locations

1220 Irmscher Blvd
#6681
Celina, OH 45822

NPI Registry JSON

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308009600000",
    "number": "1871765362",
    "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 PODIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2011-06-14",
        "status": "A",
        "authorized_official_last_name": "SWONGER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "PODIATRIST/OWNER-PRESIDENT",
        "authorized_official_telephone_number": "41958687874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36 002772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2056313",
            "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 Jun 14, 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.