Provider Demographics
NPI:1396873998
Name:PREMIER FOOT & ANKLE CENTER, P.C.
Entity type:Organization
Organization Name:PREMIER FOOT & ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-450-1144
Mailing Address - Street 1:675 NORTH BROAD STREET
Mailing Address - Street 2:EXT. #2
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-5808
Mailing Address - Country:US
Mailing Address - Phone:724-450-1144
Mailing Address - Fax:724-450-1140
Practice Address - Street 1:675 NORTH BROAD STREET
Practice Address - Street 2:EXT. #2
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-5808
Practice Address - Country:US
Practice Address - Phone:724-450-1144
Practice Address - Fax:724-450-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004663L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty