1194744334 NPI number — KENION PODIATRY ASSOCIATES PC

Table of content: (NPI 1194744334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194744334 NPI number — KENION PODIATRY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENION PODIATRY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194744334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1163 INTERCHANGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHIGHTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18235-9068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-377-5544
Provider Business Mailing Address Fax Number:
610-377-6744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1163 INTERCHANGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-9068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-5544
Provider Business Practice Location Address Fax Number:
610-377-6744
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KENION
Authorized Official First Name:
GUY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
610-377-5544

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  SC002248L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03196300 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90436 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 090436 . This is a "MEDICARE GROUP PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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