Provider Demographics
NPI:1740329218
Name:RAYSTOWN PODIATRY ASSOCIATES
Entity type:Organization
Organization Name:RAYSTOWN PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-643-5193
Mailing Address - Street 1:908 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1826
Mailing Address - Country:US
Mailing Address - Phone:814-643-5565
Mailing Address - Fax:814-643-2607
Practice Address - Street 1:908 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1826
Practice Address - Country:US
Practice Address - Phone:814-643-5565
Practice Address - Fax:814-643-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001976-L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295443OtherAAG BENEFIT PLAN ADMINIST
PA50001941OtherCAPITAL BLUE CROSS
PA21298OtherGEISSINGER HEALTH PLAN
TX0004390700OtherAETNA
PA335768OtherHEALTH AMERICA PENNSYLVAN
FL25363650OtherPENN TREATY NETWORK AM IN
WA338060OtherCOMBINED INSURANCE CO OF
TX=========OtherV.A. FINANCIAL SERVICES C
FL25363650OtherPENN TREATY NETWORK AM IN
PA335768OtherHEALTH AMERICA PENNSYLVAN
OH=========OtherSTATEFARM HEALTH INS
TX0004390700OtherAETNA
PA21298OtherGEISSINGER HEALTH PLAN
WA338060OtherCOMBINED INSURANCE CO OF
PA=========OtherHOP ADMINISTRATION UNIT
PA=========OtherPA EMPLOYES BENEFIT TRUST
FL=========OtherAMERICAN GENERAL LIFE & A