Provider Demographics
NPI:1154496891
Name:WESTERN PA FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:WESTERN PA FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-371-9330
Mailing Address - Street 1:1789 S BRADDOCK AVE
Mailing Address - Street 2:SUITE 365
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1842
Mailing Address - Country:US
Mailing Address - Phone:412-371-9330
Mailing Address - Fax:412-371-8167
Practice Address - Street 1:1789 S BRADDOCK AVE
Practice Address - Street 2:SUITE 365
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1842
Practice Address - Country:US
Practice Address - Phone:412-371-9330
Practice Address - Fax:412-371-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003826L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014743320004Medicaid
PA0014743320004Medicaid
PA162283Medicare ID - Type Unspecified