1972797199 NPI number — ALL FLORIDA PODIATRY, P.A.

Table of content: (NPI 1972797199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972797199 NPI number — ALL FLORIDA PODIATRY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL FLORIDA PODIATRY, P.A.
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:
1972797199
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:
5760 10TH AVENUE NORTH
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:
33710-6432
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:
5101 BRITTANY DR S
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:
33715-1565
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:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLALUCE
Authorized Official First Name:
KIMBERLEE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
727-384-1111

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  PO2815 , 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: 11010101 . This is a "CITRUSCAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 163508 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 163508 . This is a "PCHS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65644 . This is a "BLUE CROSS BLUE SHEILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2700633 . This is a "UNITED" identifier . 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".




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