Provider Demographics
NPI:1922303056
Name:FOOTCARE SERVICES, INC.
Entity Type:Organization
Organization Name:FOOTCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-672-0400
Mailing Address - Street 1:45 E ORANGE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-5123
Mailing Address - Country:US
Mailing Address - Phone:717-672-0400
Mailing Address - Fax:717-824-3466
Practice Address - Street 1:45 E ORANGE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-5123
Practice Address - Country:US
Practice Address - Phone:717-672-0400
Practice Address - Fax:717-824-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC 006160261QP1100X
PASC006166332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102552374 0001Medicaid
PA202554OtherMEDICARE PTAN GROUP NUMBER
PA202554OtherMEDICARE PTAN GROUP NUMBER
PA202553YDP4Medicare PIN