MEDICARE: PREMIER PODIATRY GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1376527226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PODIATRY GROUP PC

Provider Business Mailing Address
First Line	:	3133 NEW GERMANY RD
Second Line	:	SUITE 62
City	:	EBENSBURG
State	:	PA
Zip	:	15931-4348
Country	:	US
Telephone Number	:	814-472-2660
Fax Number	:	814-472-2666

Provider Business Practice Location Address
First Line	:	3133 NEW GERMANY RD
Second Line	:	SUITE 62
City	:	EBENSBURG
State	:	PA
Zip	:	15931-4348
Country	:	US
Telephone Number	:	814-472-2660
Fax Number	:	814-472-2666

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAUREEN RATCHFORD
Credential	:	DPM
Telephone Number	:	814-472-2600

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	04/18/2024

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