MEDICARE: KINGSMOUNT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1396914818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSMOUNT INC.

Provider Business Mailing Address
First Line	:	FOOT COMFORT CENTER
Second Line	:	9808 BUSTLETON AVE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115
Country	:	US
Telephone Number	:	215-676-7463
Fax Number	:	215-676-1110

Provider Business Practice Location Address
First Line	:	FOOT COMFORT CENTER
Second Line	:	4733 FRANKFORD AVE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124
Country	:	US
Telephone Number	:	215-744-7463
Fax Number	:

Authorized Official
Title or Position	:	MANAGER - PEDORTHIST
Name	:	MRS. SOFYA TAMARKIN
Credential	:	BCP
Telephone Number	:	215-676-7463

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	11/25/2008

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Directions to “KINGSMOUNT INC. ” Practice Location

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