Provider Demographics
NPI:1619199478
Name:THE FOOT AND ANKLE WELLNESS CENTER OF WESTERN PENNSYLVANIA, INC
Entity Type:Organization
Organization Name:THE FOOT AND ANKLE WELLNESS CENTER OF WESTERN PENNSYLVANIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-445-3053
Mailing Address - Street 1:313 FORD ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1268
Mailing Address - Country:US
Mailing Address - Phone:724-763-4080
Mailing Address - Fax:
Practice Address - Street 1:313 FORD ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1268
Practice Address - Country:US
Practice Address - Phone:724-763-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004742-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14472118706OtherPROVIDER NPI
PA6363540001Medicare NSC