Provider Demographics
NPI:1750478285
Name:ALBRIGHT FOOTCARE CENTER LLC
Entity Type:Organization
Organization Name:ALBRIGHT FOOTCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-524-2119
Mailing Address - Street 1:2330 SAINT MARY ST WEST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-8805
Mailing Address - Country:US
Mailing Address - Phone:570-524-2119
Mailing Address - Fax:570-524-5119
Practice Address - Street 1:2330 SAINT MARY ST WEST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-8805
Practice Address - Country:US
Practice Address - Phone:570-524-2119
Practice Address - Fax:570-524-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103677Medicare PIN
PA5778120001Medicare NSC