Provider Demographics
NPI:1164985438
Name:FLEETWOOD FOOTCARE CENTER, PC
Entity Type:Organization
Organization Name:FLEETWOOD FOOTCARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-944-6537
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-0425
Mailing Address - Country:US
Mailing Address - Phone:610-944-6537
Mailing Address - Fax:610-944-8544
Practice Address - Street 1:321 N FURNACE ST STE 50
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2057
Practice Address - Country:US
Practice Address - Phone:610-582-3668
Practice Address - Fax:610-404-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLEETWOOD FOOTCARE CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty