1225131626 NPI number — DUNDEE PODIATRY AND THERAPY SERVICES PA

Table of content: (NPI 1225131626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225131626 NPI number — DUNDEE PODIATRY AND THERAPY SERVICES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNDEE PODIATRY AND THERAPY SERVICES PA
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:
Provider Other Organization Name Type Code:
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:
1225131626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 LAKE LINK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33884-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-439-4000
Provider Business Mailing Address Fax Number:
863-439-2257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNDEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33838-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-439-4000
Provider Business Practice Location Address Fax Number:
863-439-2257
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
ANN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
863-439-4000

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO2449 , 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: 4475990001 . This is a "PALMETTO GBA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 340224000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480033826 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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