Organization
KINGSMOUNT INC.
Active
Other names
Foot Comfort Center - Italian Shoe Warehouse
Organization subpart
No
Provider details
NPI number
Authorized official
SOFYA TAMARKIN (MANAGER)
(215) 676-7463
Entity
Organization
Contact information
Practice address
9808 BUSTLETON AVE, PHILADELPHIA, PA 19115-2190
(215) 676-7463
Mailing address
9808 BUSTLETON AVE, PHILADELPHIA, PA 19115-2190
(215) 676-7463
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000005644
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005147000
PROV ID - KEYSTONE HPE
PA
05
—
0018439280002
—
PA
01
—
1148890
PROV ID- KEYSTONE MERCY
PA
01
—
240588
PROV ID - BLUE CROSS
PA
01
—
AMERICHOICE
01843928-01
PA
01
—
HEALTH PARTNERS
31636
PA
Enumeration date
07/10/2006
Last updated
08/02/2007
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