Healthcare Provider Details

I. General information

NPI: 1669647558
Provider Name (Legal Business Name): PREMIER PODIATRY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 NEW GERMANY RD SUITE 62
EBENSBURG PA
15931-4348
US

IV. Provider business mailing address

3133 NEW GERMANY RD SUITE 62
EBENSBURG PA
15931-4348
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-2660
  • Fax: 814-472-2666
Mailing address:
  • Phone: 814-472-2660
  • Fax: 814-472-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN RATCHFORD
Title or Position: PRESIDENT
Credential: DPM
Phone: 814-472-2660