Provider Demographics
NPI:1972872414
Name:PRIMARY PODIATRIC MEDICINE CARE CENTER
Entity Type:Organization
Organization Name:PRIMARY PODIATRIC MEDICINE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SAPKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-222-2160
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:1874 WEST CHESTNUT STREET
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-0043
Mailing Address - Country:US
Mailing Address - Phone:724-222-2160
Mailing Address - Fax:724-222-1462
Practice Address - Street 1:1874 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2638
Practice Address - Country:US
Practice Address - Phone:724-222-2160
Practice Address - Fax:724-222-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004525R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty