1871822213 NPI number — QUALITY PODIATRY GROUP OF FL LTD

Table of content: (NPI 1871822213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871822213 NPI number — QUALITY PODIATRY GROUP OF FL LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY PODIATRY GROUP OF FL LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
QUALITY PODIATRY GROUP OF FLORIDA CO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871822213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7025 BERACASA WAY
Provider Second Line Business Mailing Address:
UNIT #102-G
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-975-2090
Provider Business Mailing Address Fax Number:
847-674-2113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7025 BERACASA WAY
Provider Second Line Business Practice Location Address:
UNIT #102-G
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-975-2090
Provider Business Practice Location Address Fax Number:
847-674-2113
Provider Enumeration Date:
12/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEISER
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-975-2090

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  HCC8620 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001736000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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