Provider Demographics
NPI:1255500773
Name:KINGSMOUNT INC
Entity Type:Organization
Organization Name:KINGSMOUNT INC
Other - Org Name:FOOT COMFORT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER - PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:SOFYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCP
Authorized Official - Phone:215-676-7463
Mailing Address - Street 1:FOOT COMFORT CENTER
Mailing Address - Street 2:9808 BUSTLETON AVE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115
Mailing Address - Country:US
Mailing Address - Phone:215-676-7463
Mailing Address - Fax:215-676-1110
Practice Address - Street 1:303 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2115
Practice Address - Country:US
Practice Address - Phone:215-733-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3987700002Medicare NSC