Provider Demographics
NPI:1467428300
Name:BRADFORD FOOT AND ANKLE SPECIALTIES
Entity Type:Organization
Organization Name:BRADFORD FOOT AND ANKLE SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-297-2118
Mailing Address - Street 1:1143 NORTHERN BLVD
Mailing Address - Street 2:#170
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2221
Mailing Address - Country:US
Mailing Address - Phone:570-451-3910
Mailing Address - Fax:570-451-3236
Practice Address - Street 1:105 JOHN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1117
Practice Address - Country:US
Practice Address - Phone:570-297-2118
Practice Address - Fax:570-297-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003249L335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4926360001Medicare NSC