Provider Demographics
NPI:1346395258
Name:LOVELY FOOT ASSOCIATES PC
Entity Type:Organization
Organization Name:LOVELY FOOT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-266-6164
Mailing Address - Street 1:1454 SCALP AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3321
Mailing Address - Country:US
Mailing Address - Phone:814-266-6164
Mailing Address - Fax:814-269-2306
Practice Address - Street 1:1454 SCALP AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3321
Practice Address - Country:US
Practice Address - Phone:814-266-6164
Practice Address - Fax:814-269-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003125L213E00000X
PASC004705L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA408488LJZMedicare ID - Type Unspecified
PAU82341Medicare UPIN
PA043195LJZMedicare ID - Type Unspecified
PAT30227Medicare UPIN