1821078072 NPI number — CENTER FOR FOOT & ANKLE SURGERY PC

Table of content: (NPI 1821078072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821078072 NPI number — CENTER FOR FOOT & ANKLE SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR FOOT & ANKLE SURGERY 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:
1821078072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
684 WEST LINCOLN HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-269-0800
Provider Business Mailing Address Fax Number:
610-269-0510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
684 WEST LINCOLN HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-269-0800
Provider Business Practice Location Address Fax Number:
610-269-0510
Provider Enumeration Date:
01/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-269-0800

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC004822L , 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: CH1611607 . This is a "HIGHMARK BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30021513 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2288929000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1624760 . This is a "BLUE CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1611607 . This is a "PERSONAL CHOICE BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com