Provider Demographics
NPI: | 1710439344 |
---|---|
Name: | COMPREHENSIVE FAMILY FOOT CARE, LLC |
Entity Type: | Organization |
Organization Name: | COMPREHENSIVE FAMILY FOOT CARE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/OPERATOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JILL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | EPSTEIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 610-349-6703 |
Mailing Address - Street 1: | 75 SUNGLO DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LEESPORT |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19533-8673 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-349-6703 |
Mailing Address - Fax: | 610-691-0642 |
Practice Address - Street 1: | 35 E ELIZABETH AVE |
Practice Address - Street 2: | SUITE 13 |
Practice Address - City: | BETHLEHEM |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18018-6505 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-867-4180 |
Practice Address - Fax: | 610-691-0642 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-31 |
Last Update Date: | 2016-10-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | SC004817L | 211D00000X, 213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X, 282E00000X, 282N00000X, 310400000X, 314000000X, 315D00000X, 332B00000X, 335E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty | |
No | 211D00000X | Podiatric Medicine & Surgery Service Providers | Assistant, Podiatric | Group - Single Specialty | |
No | 213EP0504X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Public Medicine | Group - Single Specialty |
No | 213EP1101X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | Group - Single Specialty |
No | 213ER0200X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | Group - Single Specialty |
No | 213ES0000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | Group - Single Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Single Specialty |
No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Single Specialty |
No | 282E00000X | Hospitals | Long Term Care Hospital | ||
No | 282N00000X | Hospitals | General Acute Care Hospital | ||
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | ||
No | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | ||
No | 315D00000X | Nursing & Custodial Care Facilities | Hospice, Inpatient | ||
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
07149LPB | Medicare PIN | ||
PA | U96185 | Medicare UPIN |