1902992225 NPI number — GORDON FOOT CARE,PA

Table of content: (NPI 1902992225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902992225 NPI number — GORDON FOOT CARE,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GORDON FOOT CARE,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:
1902992225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W 41ST ST
Provider Second Line Business Mailing Address:
SUITE #218
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-3641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-532-5630
Provider Business Mailing Address Fax Number:
305-532-2530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W 41ST ST
Provider Second Line Business Practice Location Address:
SUITE #218
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-3641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-532-5630
Provider Business Practice Location Address Fax Number:
305-532-2530
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-532-5630

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO2890 , 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: 340493500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019835300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com