NPIMap

Organization Active NPI

Pocono Podiatry Associates

  • Foot & Ankle Surgery Podiatrist
  • Tobyhanna, PA
National Provider Identifier
1639309263
Registry record updated Jun 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
SC004054-L Issued in PA
Legal business name
POCONO PODIATRY ASSOCIATES
Practice address
100 Community Dr
Ste. 206 Mountain Healthcare Center
Tobyhanna, PA 18466-8985
Phone
(570) 839-3668
NPI assigned
Jul 16, 2009
Last updated
Jun 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carol M Latzanich, D.P.M.
Title
President
Phone
(570) 839-3668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X SC004054-L PA Primary

Addresses

Primary practice location

100 Community Dr
Ste. 206 Mountain Healthcare Center
Tobyhanna, PA 18466-8985

Mailing address

100 Community Dr Ste 206
Mountain Healthcare Center
Tobyhanna, PA 18466-8987
Phone (570) 839-3668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930009286 PA DME Supplier - Physician - Podiatry 8224009352 Practice locations: Tobyhanna, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pocono Podiatry Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 Community Dr
Ste 206
Tobyhanna, PA 18466
Phone (570) 839-3668

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1639309263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COMMUNITY DR STE 206",
            "address_2": "MOUNTAIN HEALTHCARE CENTER",
            "city": "TOBYHANNA",
            "state": "PA",
            "postal_code": "184668987",
            "telephone_number": "570-839-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COMMUNITY DR",
            "address_2": "STE. 206 MOUNTAIN HEALTHCARE CENTER",
            "city": "TOBYHANNA",
            "state": "PA",
            "postal_code": "184668985",
            "telephone_number": "570-839-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCONO PODIATRY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "LATZANICH",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-839-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC004054-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tobyhanna, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.