Provider Demographics
NPI:1225016116
Name:KEYSTONE PODIATRIC MEDICAL ASSOCIATES P C
Entity Type:Organization
Organization Name:KEYSTONE PODIATRIC MEDICAL ASSOCIATES P C
Other - Org Name:BIGLERVILLE FOOT & ANKLE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-677-9288
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307-0526
Mailing Address - Country:US
Mailing Address - Phone:717-677-9288
Mailing Address - Fax:717-677-4196
Practice Address - Street 1:23 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BIGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17307-0526
Practice Address - Country:US
Practice Address - Phone:717-677-9288
Practice Address - Fax:717-677-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016004560011Medicaid
PAV04020Medicare UPIN
PAT29391Medicare UPIN
PAU99880Medicare UPIN
PA0016004560011Medicaid
PAT72736Medicare UPIN
PA1149270001Medicare NSC
PAV00289Medicare UPIN
PAV04020Medicare UPIN