Provider Demographics
NPI:1790900918
Name:BUCKS COUNTY REHAB & WELLNESS CTR
Entity Type:Organization
Organization Name:BUCKS COUNTY REHAB & WELLNESS CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEDICUM
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-529-6511
Mailing Address - Street 1:1040 S WEST END BLVD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2634
Mailing Address - Country:US
Mailing Address - Phone:215-529-7246
Mailing Address - Fax:215-529-6512
Practice Address - Street 1:1040 S WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2634
Practice Address - Country:US
Practice Address - Phone:215-529-7246
Practice Address - Fax:215-529-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC00551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1418761OtherBLUE SHIELD
PA1418639OtherBLUE SHIELD
PA2105345000OtherKEYSTONE
PA2103588000OtherKEYSTONE
PA7802379OtherAETNA
PA50016192OtherCAPITAL BLUE
PA1417165OtherBLUE SHIELD
PA063480OtherPIN NUMBER
PA50010317OtherCAPITAL BLUE
PA564698OtherBLUE SHIELD
PA564698OtherBLUE SHIELD
PAU92384Medicare ID - Type Unspecified
PA7802379OtherAETNA
PAU92384Medicare UPIN
PAP00276464Medicare ID - Type Unspecified