Provider Demographics
NPI:1609293737
Name:ADVANCED FOOT AND ANKLE OF SOUTHWEST PA
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE OF SOUTHWEST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-439-1300
Mailing Address - Street 1:104 DELAWARE AVE
Mailing Address - Street 2:SUITE 246
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3100
Mailing Address - Country:US
Mailing Address - Phone:724-439-1300
Mailing Address - Fax:724-439-8727
Practice Address - Street 1:104 DELAWARE AVE
Practice Address - Street 2:SUITE 246
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3100
Practice Address - Country:US
Practice Address - Phone:724-439-1300
Practice Address - Fax:724-439-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003555R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU16801Medicare UPIN