Healthcare Provider Details

I. General information

NPI: 1811172109
Provider Name (Legal Business Name): COMPLETE FAMILY FOOT CARE CENTER,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 LUMBER ST SUITE B
LITTLESTOWN PA
17340-1668
US

IV. Provider business mailing address

340 LUMBER ST SUITE B
LITTLESTOWN PA
17340-1668
US

V. Phone/Fax

Practice location:
  • Phone: 717-359-5300
  • Fax: 717-359-0775
Mailing address:
  • Phone: 717-359-5300
  • Fax: 717-359-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017012250003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. DONNA M REAVER
Title or Position: OFFICE MANAGER
Credential:
Phone: 717-359-5300