1003032509 NPI number — ALL FLORIDA PODIATRY PA

Table of content: (NPI 1003032509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003032509 NPI number — ALL FLORIDA PODIATRY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL FLORIDA PODIATRY 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:
1003032509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33733-3165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-384-1111
Provider Business Mailing Address Fax Number:
727-384-1112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5760 10TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-6432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-384-1111
Provider Business Practice Location Address Fax Number:
727-384-1112
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLALUCE
Authorized Official First Name:
MARC
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER PODIATRIST
Authorized Official Telephone Number:
727-384-1111

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO 2815 , 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: 649524 . This is a "TUFTS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 111877 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2700633 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65644 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 163508 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 21212024000 . This is a "BEECHSTREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11010101 . This is a "CITRUS CAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1734395 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010981200 . 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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