GRAND LAKE PODIATRY, INC. (NPI# 1548377500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548377500 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE PODIATRY, INC. |
| Practice Address |
148 N Main St Bluffton OH 45817-1246 |
| Mailing Address |
1222 Irmscher Blvd Celina OH 45822-8305 |
| Practice Telephone | 4193583050 |
| Practice Fax Number | 4193580240 |
| Mailing Telephone | 4195867874 |
| Mailing Fax Number | 4195862776 |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2008-04-18 |
| 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 |
Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2057929 | 05 |
| Street Address |
148 N MAIN ST |
| City | BLUFFTON |
| State | OH |
| Zip Code | 45817-1246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891017257 | Bluffton Foot and Ankle | Podiatrist | 148 N Main St, Bluffton, OH 45817-1246 | 2010-02-25 |
| 1093838575 | Daniel Wayne Kirk | Podiatrist | 148 N Main St, Bluffton, OH 45817-1246 | 2007-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063969178 | Kearstin Barry | Student in an Organized Health Care Education/Training Program | 8310 Hillville Rd, Bluffton, OH 45817 | 2016-09-07 |
| 1568854347 | Bluffton Pediatrics | Nurse Practitioner | 505 E Jefferon Street, Suite A, Bluffton, OH 45817 | 2015-03-03 |
| 1205957537 | Orthopaedic Institute of Ohio | Orthopaedic Surgery | 139 Garau St., Blanchard Valley Hospital, Bluffton, OH 45817 | 2007-04-03 |
| 1891832440 | Bluffton Village | Ambulance | 115 East Washington Street, Bluffton, OH 45817 | 2007-01-31 |
| 1942362314 | Elizabeth Ann Patterson | Chiropractor | 900 N Main Street, Suite B, Bluffton, OH 45817 | 2006-12-14 |
| 1992811608 | Phillip C Weisenberger | Dentist | 122 Thurman St, Bluffton, OH 45817 | 2006-08-23 |
| 1689625543 | Desrene K Brown | Obstetrics & Gynecology | 547 Harmon Rd, Bluffton, OH 45817 | 2006-05-15 |
| 1548731706 | Laura Selvidio | Advanced Practice Midwife | 559 Harmon Rd, Bluffton, OH 45817 | 2018-12-16 |
| 1558429746 | Marion I Shelly | Family Medicine | 132 Garau Street, Bluffton Physicians Inc, Bluffton, OH 45817-0069 | 2006-12-04 |
| 1417021692 | Matthew P Ellerbrock | Chiropractor | 120 N Main St, Suite A, Bluffton, OH 45817-0205 | 2006-11-20 |
| Find all providers in zip 45817 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548443682 | Southern Foot & Ankle Center PC | Podiatrist | 14 Okatie Center Blvd S Bldg 14, Suite 101, Bluffton, SC 29909-7506 | 2007-12-12 |
| 1720420748 | Kristin Ruth Toliver | Podiatrist | 303 S. Main Street, Bluffton, IN 46714 | 2013-07-18 |
| 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 | ||||
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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.