1932647617 NPI number — GENESIS FOOT AND ANKLE INSTITUTE, INC.

Table of content: (NPI 1932647617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932647617 NPI number — GENESIS FOOT AND ANKLE INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS FOOT AND ANKLE INSTITUTE, 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:
1932647617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4615 CAPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463-8184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 N CONGRESS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-907-7631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MICHEL
Authorized Official First Name:
KARL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / PHYSICIAN
Authorized Official Telephone Number:
786-246-8562

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , 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: 024719900 . 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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