Provider Demographics
NPI:1053436782
Name:COLUMBUS FOOT AND ANKLE CLINIC, PC
Entity type:Organization
Organization Name:COLUMBUS FOOT AND ANKLE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HLADIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-372-6274
Mailing Address - Street 1:360 PLAZA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2960
Mailing Address - Country:US
Mailing Address - Phone:812-372-6274
Mailing Address - Fax:812-372-9357
Practice Address - Street 1:360 PLAZA DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2960
Practice Address - Country:US
Practice Address - Phone:812-372-6274
Practice Address - Fax:812-372-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000873213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200183180Medicaid
INU50185Medicare UPIN
083570Medicare PIN
1257070001Medicare NSC