Provider Demographics
NPI:1407963077
Name:WESTMORELAND COUNTY PODIATRY
Entity Type:Organization
Organization Name:WESTMORELAND COUNTY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-861-4114
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:PA
Mailing Address - Zip Code:15663
Mailing Address - Country:US
Mailing Address - Phone:724-861-4114
Mailing Address - Fax:724-811-4115
Practice Address - Street 1:28 FAIRWOOD DR.
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642
Practice Address - Country:US
Practice Address - Phone:724-861-4114
Practice Address - Fax:724-811-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC 003849L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14345OtherADVANTRA
1529521OtherGATEWAY
101617OtherUPMC
480014940OtherPALMETTO RRMC
000000060208OtherUNISON
PA0014301310007Medicaid
184704OtherHIGH MARK
5572494OtherAETNA
9933620OtherCIGNA
9933620OtherCIGNA
14345OtherADVANTRA