Basic Information
| Provider Information | |||||||||
| NPI: | 1083064182 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHENS MEDICAL ASSOCIATES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ATHENS MEDICAL ASSOCIATES PODIATRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405925799 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405925799 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 08/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | STEENROD | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7405664662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CMA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 36002856 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
No ID Information.