Provider Demographics
NPI:1790941508
Name:BEAVER VALLEY FOOT CLINIC, PC
Entity Type:Organization
Organization Name:BEAVER VALLEY FOOT CLINIC, PC
Other - Org Name:ADVANCED VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIMOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:878-313-3338
Mailing Address - Street 1:500 MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:878-313-3338
Mailing Address - Fax:878-313-3339
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:878-313-3338
Practice Address - Fax:878-313-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center