1306160270 NPI number — PODIATRY FOOT AND ANKLE CARE PLLC

Table of content: (NPI 1306160270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306160270 NPI number — PODIATRY FOOT AND ANKLE CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY FOOT AND ANKLE CARE PLLC
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:
1306160270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5415 PARK ST N
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33709-1087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-544-5425
Provider Business Mailing Address Fax Number:
727-544-5440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5415 PARK ST N
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33709-1087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-544-5425
Provider Business Practice Location Address Fax Number:
727-544-5440
Provider Enumeration Date:
03/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MENENDEZ
Authorized Official First Name:
JULIAN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
727-544-5425

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO3257 , 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: 1306160270 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 615430600 . This is a "OFFICE OF WORKERS COMPENSATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00835981 . This is a "RR MEDICARE INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3482826 . This is a "MAIL HANDLERS BENEFIT PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65944 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CY302A . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 615430600 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6413570001 . This is a "DME SUPPLIER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1360219 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DQ3766 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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