Provider Demographics
NPI:1275644767
Name:HELLERTOWN FAMILY FOOT CARE, INC.
Entity Type:Organization
Organization Name:HELLERTOWN FAMILY FOOT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-838-6808
Mailing Address - Street 1:725 EASTON ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1502
Mailing Address - Country:US
Mailing Address - Phone:610-838-6808
Mailing Address - Fax:610-838-5333
Practice Address - Street 1:725 EASTON ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1502
Practice Address - Country:US
Practice Address - Phone:610-838-6808
Practice Address - Fax:610-838-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003773L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013944740005Medicaid
PA4800290589OtherPALMETTO
PA1212400001Medicare NSC
PA4800290589OtherPALMETTO
PA0013944740005Medicaid