Provider Demographics
NPI:1679758098
Name:EDWARD JOHN TROWBRIDGE
Entity type:Organization
Organization Name:EDWARD JOHN TROWBRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-643-6900
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0358
Mailing Address - Country:US
Mailing Address - Phone:814-643-6900
Mailing Address - Fax:814-643-6900
Practice Address - Street 1:605 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1713
Practice Address - Country:US
Practice Address - Phone:814-643-6900
Practice Address - Fax:814-643-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4913220001Medicare NSC