MEDICARE: DR. JESSE AIDEN MYTINGER DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC005745	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821071382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE AIDEN MYTINGER DPM

Provider Business Mailing Address
First Line	:	1601 UNION AVE
Second Line	:	SUITE B
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2133
Country	:	US
Telephone Number	:	724-226-0544
Fax Number	:	724-226-2172

Provider Business Practice Location Address
First Line	:	127 COLUMBIA AVE
Second Line	:
City	:	VANDERGRIFT
State	:	PA
Zip	:	15690-1101
Country	:	US
Telephone Number	:	724-567-7520
Fax Number	:	724-568-2169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	12/17/2012

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