GRAND LAKE PODIATRY INC (NPI# 1184896383) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184896383 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE PODIATRY INC |
| Practice Address |
3772 Us Rt 68 S Bellefontaine OH 43311-3311 |
| Mailing Address |
1222 Irmscher Blvd Celina OH 45822-8305 |
| Practice Telephone | 9375993668 |
| Practice Fax Number | 9375994852 |
| Mailing Telephone | 4195867874 |
| Mailing Fax Number | 4195862776 |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2011-06-09 |
| Authorized Official Name | DR. MARY KATHERINE BENJAMIN-SWONGER (PODIATRIST/OWNER-PRESIDENT) |
| Authorized Official Telephone | 4195867874 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
36 002772 | OH | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2544858 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871765362 | Grand Lake Podiatry Inc | Podiatrist | 1222 Irmscher Blvd, Celina, OH 45822-8305 | 2008-03-25 |
| 1992977987 | Grand Lake Podiatry Inc | Podiatrist | 140 Fox Rd, Ste104, Van Wert, OH 45891-2475 | 2008-03-31 |
| 1184896177 | Grand Lake Podiatry Inc | Podiatrist | 2624 Lexington Ave, Springfield, OH 45505-2607 | 2008-03-31 |
| Street Address |
3772 US RT 68 S |
| City | BELLEFONTAINE |
| State | OH |
| Zip Code | 43311-3311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760082515 | Liza Hensley | Pharmacist | 2281 S. Main Street, Bellefontaine, OH 43311 | 2020-10-30 |
| 1285273367 | Mona Kaye Garrison | Family Medicine | 1860 S Main St, Bellefontaine, OH 43311 | 2020-01-06 |
| 1316429012 | Hana Elizabeth Fischesser | Speech-Language Pathologist | 205 Palmer Street, Bellefontaine, OH 43311 | 2018-08-30 |
| 1063934719 | Sophia Do Vang | Physician Assistant | 1860 S Main Street, Bellefontaine, OH 43311 | 2017-07-14 |
| 1164978441 | Jennifer Gaver | Specialist | 921 Rush Avenue, Bellefontaine, OH 43311 | 2016-08-28 |
| 1598186561 | Candice Nanette Stevens | Registered Nurse | 208 Blair Ave, Bellefontaine, OH 43311 | 2013-12-18 |
| 1225395361 | Nicholas J Peters | Orthopaedic Surgery | 1134 N Main St Ste 2500, Bellefontaine, OH 43311 | 2012-04-13 |
| 1679868889 | Melissa Rae Lallo | Physical Therapist | 711 Rush Avenue, Bvellefontaine, OH 43311 | 2011-06-15 |
| 1912146572 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 141 Richard Avenue, Bellefontaine, OH 43311 | 2009-02-05 |
| 1710126370 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 329 East Spring Avenue, Bellefontaine, OH 43311 | 2009-02-05 |
| Find all providers in zip 43311 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184970121 | Complete Foot and Ankle Specialists, LLC | Podiatrist | 1400 S Main St, Bellefontaine, OH 43311-1581 | 2012-07-27 |
| 1831365238 | Allied Podiatry, Inc | Podiatrist | 1400 S Main St, Suites A & B, Bellefontaine, OH 43311-1581 | 2008-05-06 |
| 1932151735 | Roger W Hamm | Podiatrist | 1400 S Main St, Suite A&b, Bellefontaine, OH 43311-1581 | 2006-05-17 |
| 1083694301 | Richard F Jennings | Podiatrist | 1400 S Main St, Bellefontaine, OH 43311-1581 | 2006-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992321228 | Mary Matta | Podiatrist | 425 West Fith Street, East Liverpool, OH 43920 | 2020-06-23 |
| 1063047942 | Jennifer C. Swan, Dpm, LLC | Podiatrist | 155 Commerce Park Dr Ste 7, Westerville, OH 43082-8384 | 2020-03-11 |
| 1518599117 | Howard Waxman | Podiatrist | 35000 Chardon Rd Ste 220, Willoughby Hills, OH 44094-9019 | 2020-02-11 |
| 1346887510 | Performance Foot and Ankle, LLC | Podiatrist | 3727 Friendsville Rd Unit 2, Wooster, OH 44691-7127 | 2019-12-05 |
| 1053971200 | Lauren Digregorio Dpm | Podiatrist | 1502 Lear Industrial Pkwy Ste 1a, Avon, OH 44011-1380 | 2019-06-19 |
| 1477117331 | North Eastern Ohio Podiatry Group LLC | Podiatrist | 4200 Warrensville Center Road, Suite 271, Warrensville Heights, OH 44122-6805 | 2019-04-26 |
| 1336611672 | Anthony G Polito Dpm Inc | Podiatrist | 4071 N Jefferson St, Medina, OH 44256-5622 | 2018-12-27 |
| 1023547957 | Phuoc Bui | Podiatrist | 4260 Glendale Mildford Rd. Ste 103, Blue Ash, OH 45242 | 2017-06-05 |
| 1639606619 | David Mathew Bishop | Podiatrist | 200 East State St, Alliance Community Hospital, Alliance, OH 44601 | 2017-05-22 |
| 1174058630 | Lance Jon Johnson | Podiatrist | 1400 W Main St Bldg 1, Suite A, Bellevue, OH 44811-9429 | 2017-04-21 |
| Find all providers with the same taxonomy | ||||
| City | BELLEFONTAINE |
| Zip Code | 43311 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.