Provider Demographics
NPI:1417114471
Name:COUNTY OF MONTGOMERY PODIATRY
Entity Type:Organization
Organization Name:COUNTY OF MONTGOMERY PODIATRY
Other - Org Name:PARKHOUSE PROVIDENCE POINTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBLASE
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:610-792-2224
Mailing Address - Street 1:1600 BLACK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3147
Mailing Address - Country:US
Mailing Address - Phone:610-792-2224
Mailing Address - Fax:
Practice Address - Street 1:1600 BLACK ROCK RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3147
Practice Address - Country:US
Practice Address - Phone:610-792-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKHPUSE PROVIDENCE POINTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA178087OtherPROVIDER #
PA480027673OtherRAIROAD #
PA1548212061OtherNPI#
PA1548212061OtherNPI#
PA480027673OtherRAIROAD #