Provider Demographics
NPI:1902139504
Name:KINGSMOUNT INC
Entity Type:Organization
Organization Name:KINGSMOUNT INC
Other - Org Name:FOOT COMFORT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOFYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:C PED,, MBA
Authorized Official - Phone:2153-003-3355
Mailing Address - Street 1:9808 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2190
Mailing Address - Country:US
Mailing Address - Phone:215-676-7463
Mailing Address - Fax:215-676-1110
Practice Address - Street 1:2917 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2802
Practice Address - Country:US
Practice Address - Phone:215-739-7463
Practice Address - Fax:215-739-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3987700007Medicare NSC