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Organization
BRADFORD FOOT AND ANKLE SPECIALTIES
Active
Organization
BRADFORD FOOT AND ANKLE SPECIALTIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY M KUMP DPM (OWNER)
(570) 265-7700
Entity
Organization
Contact information
Practice address
1786 GOLDEN MILE RD, SUITE 1, TOWANDA, PA 18848-9733
(570) 265-7700
(570) 268-4266
Mailing address
PO BOX 376, WYSOX, PA 18854-0376
(570) 265-7700
(570) 268-4266
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC003249L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025528480001
—
PA
01
—
206545
MEDICARE PTAN
—
Enumeration date
08/02/2006
Last updated
04/17/2013
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