Healthcare Provider Details

I. General information

NPI: 1922303056
Provider Name (Legal Business Name): FOOTCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E ORANGE ST LOWER LEVEL
LANCASTER PA
17602-5123
US

IV. Provider business mailing address

45 E ORANGE ST LOWER LEVEL
LANCASTER PA
17602-5123
US

V. Phone/Fax

Practice location:
  • Phone: 717-672-0400
  • Fax: 717-824-3466
Mailing address:
  • Phone: 717-672-0400
  • Fax: 717-824-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberSC 006160
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC006166
License Number StatePA

VIII. Authorized Official

Name: ASTRID AVIS
Title or Position: DOCTOR OF PODIATRIC MEDICINE
Credential: DPM
Phone: 717-672-0400