Provider Demographics
NPI:1487837498
Name:ADVENT FOOT AND ANKLE INC.
Entity Type:Organization
Organization Name:ADVENT FOOT AND ANKLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-449-8670
Mailing Address - Street 1:509 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2110
Mailing Address - Country:US
Mailing Address - Phone:570-249-1021
Mailing Address - Fax:
Practice Address - Street 1:107 W CENTRE ST
Practice Address - Street 2:
Practice Address - City:MAHANOY CITY
Practice Address - State:PA
Practice Address - Zip Code:17948-2605
Practice Address - Country:US
Practice Address - Phone:570-449-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005660213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016034230002Medicaid
PA2011068OtherHIGHMARK BCBS PA
PA1016034230002Medicaid
PA120247Medicare PIN