Provider Demographics
NPI:1780869644
Name:KENT V. FLINCHBAUGH DPM LTD.
Entity type:Organization
Organization Name:KENT V. FLINCHBAUGH DPM LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:V
Authorized Official - Last Name:FLINCHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-464-2751
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-0216
Mailing Address - Country:US
Mailing Address - Phone:717-464-2751
Mailing Address - Fax:717-464-7261
Practice Address - Street 1:2600 WILLOW STREET PIKE S
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9377
Practice Address - Country:US
Practice Address - Phone:717-464-2751
Practice Address - Fax:717-464-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002310L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0878340001Medicare NSC
PAT30249Medicare UPIN