Provider Demographics
NPI:1316045396
Name:KEYSTONE FOOT AND ANKLE ASSOCIATES, PC
Entity Type:Organization
Organization Name:KEYSTONE FOOT AND ANKLE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:URBAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-604-0734
Mailing Address - Street 1:100 W SPROUL RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2033
Mailing Address - Country:US
Mailing Address - Phone:610-604-0734
Mailing Address - Fax:610-604-0846
Practice Address - Street 1:100 W SPROUL RD
Practice Address - Street 2:SUITE 122
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2033
Practice Address - Country:US
Practice Address - Phone:610-604-0734
Practice Address - Fax:610-604-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002791L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01287625Medicaid
PA01287625Medicaid
PA586578Medicare PIN
T77859Medicare UPIN