Provider Demographics
NPI:1699895037
Name:UPPER BUCKS FOOT & ANKLE MEDICAL CENTER PC
Entity type:Organization
Organization Name:UPPER BUCKS FOOT & ANKLE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEDICUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-529-6511
Mailing Address - Street 1:249 S WEST END BLVD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1160
Mailing Address - Country:US
Mailing Address - Phone:215-529-6511
Mailing Address - Fax:215-529-6512
Practice Address - Street 1:249 S WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1160
Practice Address - Country:US
Practice Address - Phone:215-529-6511
Practice Address - Fax:215-529-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005511213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2103588000OtherKEYSTONE
613516600OtherDEPARTMENT OF LABOR OWCP
PABS7453981OtherINSURANCE
PA063480OtherINSURANCE
PA50016192OtherCAPITAL INDIVIDUAL
PA7802379OtherAETNA PPO
PA2941264OtherAETNA HMO
PA063479Q2KOtherINSURANCE
PA1417165OtherBS INDIVIDUAL
PA1418639OtherINSURANCE
PAP00276464OtherINSURANCE
PA2105345000OtherKEYSTONE GROUP
PA50010317OtherCAPITAL GROUP
PA50010317OtherCAPITAL GROUP
PA7802379OtherAETNA PPO
PA=========Medicare UPIN