1245538735 NPI number — AMERICAN FOOT & ANKLE CLINIC OF TAMPA BAY, INC.

Table of content: (NPI 1245538735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245538735 NPI number — AMERICAN FOOT & ANKLE CLINIC OF TAMPA BAY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN FOOT & ANKLE CLINIC OF TAMPA BAY, 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:
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:
1245538735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5322 PRIMROSE LAKE CIR STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647-3659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-380-8346
Provider Business Mailing Address Fax Number:
813-354-4635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16350 BRUCE B. DOWNS BLVD, UNIT 46879
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-380-8346
Provider Business Practice Location Address Fax Number:
813-388-4180
Provider Enumeration Date:
03/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DONATE
Authorized Official First Name:
GUILLERMO
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
813-380-8346

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO2970 , 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: FF599A . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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