1629174446 NPI number — FOOTCARE PA

Table of content: JONNA FALKNER (NPI 1841097276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629174446 NPI number — FOOTCARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOTCARE PA
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:
1629174446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4333 N JOSEY LN
Provider Second Line Business Mailing Address:
206
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-4629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-939-1757
Provider Business Mailing Address Fax Number:
972-939-1682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4333 N JOSEY LN
Provider Second Line Business Practice Location Address:
206
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75010-4629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-939-1757
Provider Business Practice Location Address Fax Number:
972-939-1682
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASHIGIAN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
972-939-1757

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014CZ . This is a "BCBS GROUP PROV #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080689501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com