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General NPI Number Information
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NPI Number | 1407040025
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Entity Type | Organization
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Legal Business Name | PENNDOC FOOT & ANKLE CENTER, LLC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 133 MILL ST
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City | BRADFORD
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State | PA
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Zip | 16701-1408
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Country | US
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Telephone | 814-362-3668
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Fax | 814-362-0540
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | BRADFORD
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State | PA
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Zip | 16701-0040
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Country | US
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Telephone | 814-362-3668
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Fax | 814-362-0540
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Authorized Official
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Title or Position | OFFICE BILLER
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Name | HOLLY FOOT EAKIN
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Credential |
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Telephone | 181-436-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC003540L
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License Number State | PA
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