Healthcare Provider Details

I. General information

NPI: 1699797563
Provider Name (Legal Business Name): BEAVER VALLEY FOOT CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST SUITE 101
BEAVER PA
15009-2998
US

IV. Provider business mailing address

500 MARKET ST SUITE 101
BEAVER PA
15009-2998
US

V. Phone/Fax

Practice location:
  • Phone: 878-313-3338
  • Fax: 878-313-3339
Mailing address:
  • Phone: 878-313-3338
  • Fax: 878-313-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC004042L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINA TEIMOURI
Title or Position: OWNER
Credential: DPM
Phone: 878-313-3338