1316054513 NPI number — PREMIER FOOT AND ANKLE SPECIALISTS

Table of content: (NPI 1316054513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316054513 NPI number — PREMIER FOOT AND ANKLE SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER FOOT AND ANKLE SPECIALISTS
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:
PREMIER FOOT AND ANKLE SPECIALISTS
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:
1316054513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 THE RIALTO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34285-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-488-0222
Provider Business Mailing Address Fax Number:
941-480-1668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 N BREVARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34266-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-494-3478
Provider Business Practice Location Address Fax Number:
863-494-0582
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAYLINSON
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONSULTANT
Authorized Official Telephone Number:
856-582-6082

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO 1580 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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