1033439559 NPI number — PITTSBURGH FAMILY FOOT CARE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033439559 NPI number — PITTSBURGH FAMILY FOOT CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PITTSBURGH FAMILY FOOT CARE, P.C.
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:
1033439559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 WATERDAM PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
MC MURRAY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-5416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-941-9440
Provider Business Mailing Address Fax Number:
724-941-9783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 PELLIS RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-4633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-9780
Provider Business Practice Location Address Fax Number:
724-941-9783
Provider Enumeration Date:
06/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LUTHER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
KULICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-941-9440

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , 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: 0014536280001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 455380 . This is a "GROUP MEDICARE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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