Provider Demographics
NPI:1508086778
Name:BRUCE R. GANEY, INC.
Entity Type:Organization
Organization Name:BRUCE R. GANEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-366-8637
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:5074 KERNSVILLE RD.
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-0267
Mailing Address - Country:US
Mailing Address - Phone:610-366-8637
Mailing Address - Fax:610-366-7745
Practice Address - Street 1:5074 KERNSVILLE RD.
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-0267
Practice Address - Country:US
Practice Address - Phone:610-366-8637
Practice Address - Fax:610-366-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003495L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001234327Medicaid
PASC003495LOtherLICENSE
U08434Medicare UPIN
PASC003495LOtherLICENSE
PA4379620001Medicare NSC