Provider Demographics
NPI:1619069085
Name:BRUCE E ABBOTT
Entity Type:Organization
Organization Name:BRUCE E ABBOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-588-6160
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-0637
Mailing Address - Country:US
Mailing Address - Phone:724-588-6160
Mailing Address - Fax:724-588-0122
Practice Address - Street 1:110 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1250
Practice Address - Country:US
Practice Address - Phone:724-588-6160
Practice Address - Fax:724-588-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002545L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010401540003Medicaid
PA0010401540003Medicaid
0518630001Medicare NSC
PA122341Medicare PIN