1548466261 NPI number — BERKS FOOT SPECIALISTS, PC

Table of content: (NPI 1548466261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548466261 NPI number — BERKS FOOT SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKS FOOT SPECIALISTS, 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:
1548466261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4885 DEMOSS RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19606-9023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-779-4020
Provider Business Mailing Address Fax Number:
610-779-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4885 DEMOSS RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606-9023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-779-4020
Provider Business Practice Location Address Fax Number:
610-779-7044
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHOLLENBERGER
Authorized Official First Name:
BRADLY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-779-4020

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC002902L , 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: 011820330007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31854 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 688055 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000688055 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01328801 . This is a "KHP CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02363800 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0522660000 . This is a "KHP EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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