1295849867 NPI number — ORLANDO FOOT AND ANKLE CLINIC, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295849867 NPI number — ORLANDO FOOT AND ANKLE CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO FOOT AND ANKLE CLINIC, INC
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:
ORLANDO FOOT & ANKLE CLINIC
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:
1295849867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140233
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32814-0233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-423-1234
Provider Business Mailing Address Fax Number:
407-517-1040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 E CENTRAL PARKWY
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
ALTAMONTE SPRGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-331-7844
Provider Business Practice Location Address Fax Number:
407-478-3595
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RENTON
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-423-1234

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029602300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB3528 . This is a "R/R MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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