Provider Demographics
NPI:1639200413
Name:JEFFREY W. MUIR DPM PC
Entity Type:Organization
Organization Name:JEFFREY W. MUIR DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-586-0421
Mailing Address - Street 1:412 N. STATE ST.
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1062
Mailing Address - Country:US
Mailing Address - Phone:570-586-0421
Mailing Address - Fax:570-586-5634
Practice Address - Street 1:412 N. STATE ST.
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1062
Practice Address - Country:US
Practice Address - Phone:570-586-0421
Practice Address - Fax:570-586-5634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY W. MUIR DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003404L213E00000X
PASC-003404-L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011733390009Medicaid
PAT-87942Medicare UPIN
PA0011733390009Medicaid
PA4451700001Medicare NSC