Provider Demographics
NPI:1376644872
Name:FOOT CENTER OF NORTHAMPTON, PC
Entity Type:Organization
Organization Name:FOOT CENTER OF NORTHAMPTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:WEEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-584-2171
Mailing Address - Street 1:241 KING STREET
Mailing Address - Street 2:SUITE 124
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-584-2171
Mailing Address - Fax:413-584-4792
Practice Address - Street 1:241 KING STREET
Practice Address - Street 2:SUITE 124
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-2171
Practice Address - Fax:413-584-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2163213E00000X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77344OtherBCBS OF MA
MA333437OtherHARVARD PILGRIM
MA623647OtherTUFTS HEALTH PLAN
MAY78066Medicare ID - Type Unspecified
MAY77344OtherBCBS OF MA