# PENNDOC FOOT & ANKLE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407040025
- **Authorized official:** HOLLY FOOT EAKIN (OFFICE BILLER)
- **Authorized official phone:** (181) 436-2366

## Contact information

- **Practice address:** 133 MILL ST, BRADFORD, PA 16701-1408
- **Practice address phone:** (814) 362-3668
- **Practice address fax:** (814) 362-0540
- **Mailing address:** PO BOX 40, BRADFORD, PA 16701-0040
- **Mailing address phone:** (814) 362-3668
- **Mailing address fax:** (814) 362-0540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | SC003540L | PA | Yes |

## Other

- **Enumeration date:** 08/28/2007
- **Last updated:** 12/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0012260110001 | — | PA |