MEDICARE: BEECH TREE PODIATRY, P.C.

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
2	213ES0103X	Foot & Ankle Surgery Podiatrist

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	:	1922067958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEECH TREE PODIATRY, P.C.

Provider Business Mailing Address
First Line	:	1546 E MARKET ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-1255
Country	:	US
Telephone Number	:	717-843-0896
Fax Number	:	717-854-6519

Provider Business Practice Location Address
First Line	:	1546 E MARKET ST
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17403-1255
Country	:	US
Telephone Number	:	717-843-0896
Fax Number	:	717-854-6519

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FRED DON CHANTILES
Credential	:	DPM
Telephone Number	:	717-843-0896

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	03/13/2008

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