Provider Demographics
NPI:1720163496
Name:REGIONAL FOOT CENTERS PA
Entity Type:Organization
Organization Name:REGIONAL FOOT CENTERS PA
Other - Org Name:THOMAS BEMBYNISTA DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF REGIONAL FOOT CTS PA
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEMBYNISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-461-7755
Mailing Address - Street 1:10612 E 18TH
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052
Mailing Address - Country:US
Mailing Address - Phone:816-461-7755
Mailing Address - Fax:816-461-0393
Practice Address - Street 1:10612 E 18TH
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052
Practice Address - Country:US
Practice Address - Phone:816-461-7755
Practice Address - Fax:816-461-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO484213E00000X
KS196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05614Medicare UPIN
KSA645078EMedicare PIN
MOA645078AMedicare PIN