Provider Demographics
NPI:1730271222
Name:BERT J. ALTMANSHOFER,DPM AND ASSOICATE, LTD
Entity type:Organization
Organization Name:BERT J. ALTMANSHOFER,DPM AND ASSOICATE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMANSHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-696-3397
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0412
Mailing Address - Country:US
Mailing Address - Phone:814-696-3397
Mailing Address - Fax:814-696-9477
Practice Address - Street 1:1798 OLD ROUTE 220 N
Practice Address - Street 2:SUITE 201
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8341
Practice Address - Country:US
Practice Address - Phone:814-696-3397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002818L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA511605OtherHIGHMARK PROVIDER NUMBER
BA511605OtherUMWA
BA511605OtherUMWA
PA511605OtherHIGHMARK PROVIDER NUMBER