Provider Demographics
NPI:1003012808
Name:ACHILLES FOOT CENTER PSC
Entity Type:Organization
Organization Name:ACHILLES FOOT CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-888-2122
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1817
Mailing Address - Country:US
Mailing Address - Phone:570-888-2122
Mailing Address - Fax:570-882-8451
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1817
Practice Address - Country:US
Practice Address - Phone:570-888-2122
Practice Address - Fax:570-882-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002780L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063123Q0QMedicare ID - Type UnspecifiedGROUP
PA4725440001Medicare NSC
PAT72918Medicare UPIN