Provider Demographics
NPI:1821017062
Name:COLLEGE HILL PODIATRY INC
Entity Type:Organization
Organization Name:COLLEGE HILL PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-843-7010
Mailing Address - Street 1:6832 BIG BEAVER BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1803
Mailing Address - Country:US
Mailing Address - Phone:724-843-7010
Mailing Address - Fax:724-846-9938
Practice Address - Street 1:6832 BIG BEAVER BLVD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1803
Practice Address - Country:US
Practice Address - Phone:724-843-7010
Practice Address - Fax:724-846-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA511626Medicare ID - Type Unspecified