1902826829 NPI number — BERKS FOOT AND ANKLE SURGICAL ASSOCIATES, INC

Table of content: (NPI 1902826829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902826829 NPI number — BERKS FOOT AND ANKLE SURGICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKS FOOT AND ANKLE SURGICAL ASSOCIATES, INC
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:
HAMBURG PODIATRY CENTER
Provider Other Organization Name Type Code:
4
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:
1902826829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 STATE ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19526-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-562-4999
Provider Business Mailing Address Fax Number:
610-562-0221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 STATE ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19526-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-562-4999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SATTIZAHN
Authorized Official First Name:
SUZIE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
610-796-9522

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC002677-L , 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: 668116 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02340800 . This is a "CAPITOL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 668116 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010441170005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20017609 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2101100000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com