Provider Demographics
NPI:1194744334
Name:KENION PODIATRY ASSOCIATES PC
Entity type:Organization
Organization Name:KENION PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KENION
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-377-5544
Mailing Address - Street 1:1163 INTERCHANGE RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9068
Mailing Address - Country:US
Mailing Address - Phone:610-377-5544
Mailing Address - Fax:610-377-6744
Practice Address - Street 1:1163 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9068
Practice Address - Country:US
Practice Address - Phone:610-377-5544
Practice Address - Fax:610-377-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002248L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03196300OtherBLUE CROSS
PA90436OtherBLUE SHIELD
PA090436OtherMEDICARE GROUP PROVIDER #
PA4505150001Medicare NSC
PA90436OtherBLUE SHIELD