Provider Demographics
NPI:1487768446
Name:FOOT HEALTH CENTERS, P.A.
Entity type:Organization
Organization Name:FOOT HEALTH CENTERS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-795-1003
Mailing Address - Street 1:52 BERLIN RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3574
Mailing Address - Country:US
Mailing Address - Phone:856-795-1003
Mailing Address - Fax:856-795-5994
Practice Address - Street 1:6418 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2323
Practice Address - Country:US
Practice Address - Phone:215-729-4553
Practice Address - Fax:856-795-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005060570003Medicaid
PA31881OtherKEYSTONE MERCY
PA0060618000OtherKEYSTONE HEALTH PLAN EAST
PA0509880008OtherNATIONAL HERITAGE INS. CO
PA20770OtherHEALTH PARTNERS
PA005060570003Medicaid