Provider Demographics
NPI:1669647558
Name:PREMIER PODIATRY GROUP PC
Entity Type:Organization
Organization Name:PREMIER PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-472-2660
Mailing Address - Street 1:3133 NEW GERMANY RD
Mailing Address - Street 2:SUITE 62
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4348
Mailing Address - Country:US
Mailing Address - Phone:814-472-2660
Mailing Address - Fax:814-472-2666
Practice Address - Street 1:3133 NEW GERMANY RD
Practice Address - Street 2:SUITE 62
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4348
Practice Address - Country:US
Practice Address - Phone:814-472-2660
Practice Address - Fax:814-472-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5549560001Medicare NSC