Provider Demographics
NPI:1861487381
Name:ALBRIGHT FOOTCARE CENTER
Entity Type:Organization
Organization Name:ALBRIGHT FOOTCARE CENTER
Other - Org Name:ALBRIGHT FOOTCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:321 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1103
Mailing Address - Country:US
Mailing Address - Phone:570-524-2119
Mailing Address - Fax:570-524-5119
Practice Address - Street 1:321 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1103
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:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-OO4535-L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063521Medicare ID - Type Unspecified