Provider Demographics
NPI:1427178649
Name:KOPP FAMILY FOOT CARE, PC
Entity Type:Organization
Organization Name:KOPP FAMILY FOOT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-266-6124
Mailing Address - Street 1:303 BUDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3213
Mailing Address - Country:US
Mailing Address - Phone:814-266-6124
Mailing Address - Fax:
Practice Address - Street 1:303 BUDFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3213
Practice Address - Country:US
Practice Address - Phone:814-266-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003740L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA08192OtherBLUE CROSS
PA0015131540001Medicaid
PA0015131540001Medicaid
PA081921Medicare ID - Type Unspecified