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

140 Fox Rd
Ste104
Van Wert, OH 45891-2475

Phone

(419) 586-7874

Fax

(419) 586-2776

NPI assigned

Mar 31, 2008

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

Tax ID family

Grand Lake Podiatry Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Grand Lake Podiatry, Inc

  • Foot & Ankle Surgery Podiatrist
  • Minster, OH
  • NPI 1164694428
  NPD tax ID
• Grand Lake Podiatry, Inc

  • Foot & Ankle Surgery Podiatrist
  • Wapakoneta, OH
  • NPI 1538331525
  NPD tax ID

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296518400000",
    "number": "1992977987",
    "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": "140 FOX RD",
            "address_2": "STE104",
            "city": "VAN WERT",
            "state": "OH",
            "postal_code": "458912475",
            "telephone_number": "419-586-7874",
            "fax_number": "419-586-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE PODIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2011-02-01",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36 002772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2544894",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shane Raquel Gerber, C.N.P.
• Kendra German
• Tracy Gibson, LPN
• Adilynn C Girardot
• Ashlen Glenn
• Anthony W. Greutman, LSW, LICDC
• Marjorie Greve
• Sydney N Grieser
• Natalie Griffiths
• Patrick Alan Grilliot, LSW, CDCA

• Foot & Ankle Surgery Podiatrist in Van Wert, OH
• Providers in Van Wert, 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 Feb 1, 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.