Provider Demographics
NPI:1871564492
Name:WEST TEN PODIATRY CENTRE, INC.
Entity type:Organization
Organization Name:WEST TEN PODIATRY CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-835-3338
Mailing Address - Street 1:1326 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4235
Mailing Address - Country:US
Mailing Address - Phone:814-835-3338
Mailing Address - Fax:814-835-3668
Practice Address - Street 1:1326 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4235
Practice Address - Country:US
Practice Address - Phone:814-835-3338
Practice Address - Fax:814-835-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000863004Medicaid
PA4708090001Medicare NSC
PA000863004Medicaid