GRAND LAKE PODIATRY INC (NPI# 1992977987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992977987 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE PODIATRY INC |
| Practice Address |
140 Fox Rd Ste104 Van Wert OH 45891-2475 |
| Mailing Address |
1222 Irmscher Blvd Celina OH 45822-8305 |
| Practice Telephone | 4195867874 |
| Practice Fax Number | 4195862776 |
| Mailing Telephone | 4195867874 |
| Mailing Fax Number | 4195862776 |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2011-02-01 |
| 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 | 2544894 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184896383 | Grand Lake Podiatry Inc | Podiatrist | 3772 Us Rt 68 S, Bellefontaine, OH 43311-3311 | 2008-03-27 |
| 1871765362 | Grand Lake Podiatry Inc | Podiatrist | 1222 Irmscher Blvd, Celina, OH 45822-8305 | 2008-03-25 |
| 1184896177 | Grand Lake Podiatry Inc | Podiatrist | 2624 Lexington Ave, Springfield, OH 45505-2607 | 2008-03-31 |
| Street Address |
140 FOX RD STE104 |
| City | VAN WERT |
| State | OH |
| Zip Code | 45891-2475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225032964 | Matthew W. Miller | Family Medicine | 140 Fox Rd, Suite 202, Van Wert, OH 45891-2475 | 2005-06-10 |
| 1467994541 | Van Wert Medical Services, Ltd. | Podiatrist | 140 Fox Rd, Ste 209, Van Wert, OH 45891-2475 | 2016-11-07 |
| 1437521317 | Dental Center of Northwest Ohio | Clinic/Center | 140 Fox Rd, Suite 207, Van Wert, OH 45891-2475 | 2015-10-30 |
| 1215313846 | Shelley Kreeger | Specialist/Technologist | 140 Fox Rd, Suite 101, Van Wert, OH 45891-2475 | 2015-08-05 |
| 1396150272 | Allison Harting | Nurse Practitioner | 140 Fox Rd, Ste 201, Van Wert, OH 45891-2475 | 2014-06-30 |
| 1467867325 | Deborah Nicole Howell | Nurse Practitioner | 140 Fox Rd, Suiet 402, Van Wert, OH 45891-2475 | 2014-06-30 |
| 1386082923 | Kelly Jae Straley | Registered Nurse | 140 Fox Rd, Van Wert, OH 45891-2475 | 2013-06-05 |
| 1487097317 | Serenity Solutions, LLC | Psychologist | 140 Fox Rd, Suite 303, Van Wert, OH 45891-2475 | 2013-04-10 |
| 1124369350 | Van Wert Medical Services, Ltd. | General Practice | 140 Fox Rd, Suite 104, Van Wert, OH 45891-2475 | 2013-03-13 |
| 1790039196 | Kelsey Renee Brokamp | Nurse Practitioner | 140 Fox Rd, Van Wert, OH 45891-2475 | 2012-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821638172 | Katlynn A Dotson | Social Worker | 160 Fox Road, Van Wert, OH 45891 | 2020-01-14 |
| 1982107975 | Van Wert Medical Services, Ltd. | Clinic/Center | 214 Towne Center Blvd, Van Wert, OH 45891 | 2018-03-15 |
| 1871800698 | Ronetta E Marhoover | Nurse Practitioner | 1052 S Washington Street, Van Wert, OH 45891 | 2010-09-01 |
| 1780918243 | Sherry Ann Eibling | Nurse's Aide | 3683 St Rt 127n, Van Wert, OH 45891 | 2009-09-30 |
| 1053552596 | Betty Jean Miller | Massage Therapist | 7079 Us. Rt. 127 N., Van Wert, OH 45891 | 2009-03-12 |
| 1578700399 | P & R Home Iv Service Inc | Pharmacy | 16937 Defiance Trail, Van Wert, OH 45891 | 2009-01-15 |
| 1619167236 | Scott David Shie | Urology | Van Wert Health Urology, 140 Fox Rd. Ste 105, Van Wert, OH 45891 | 2007-07-30 |
| 1386866283 | John Carl Cook Jr. | Dentist | 723 W Main St, Van Wert, OH 45891 | 2007-05-02 |
| 1396866620 | Orthopaedic Institute of Ohio, Inc. | Orthopaedic Surgery | 1180 Professional Drive, Van Wert, OH 45891 | 2007-04-03 |
| 1659400224 | Hearth & Home Assisted Living | Assisted Living Facility | 1118 Westwood Drive, Van Wert, OH 45891 | 2007-03-02 |
| Find all providers in zip 45891 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205192192 | Charles J. Hoehn | Podiatrist | 140 Fox Road, Ste 104, Van Wert, OH 45891-2490 | 2012-04-05 |
| 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.