Provider Demographics
NPI:1679101760
Name:BEAVER VALLEY FOOT CLINIC PC
Entity type:Organization
Organization Name:BEAVER VALLEY FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIMOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:878-313-3338
Mailing Address - Street 1:500 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:878-313-3338
Mailing Address - Fax:878-313-3339
Practice Address - Street 1:447 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2521
Practice Address - Country:US
Practice Address - Phone:724-266-5959
Practice Address - Fax:878-313-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023237290002Medicaid