Provider Demographics
NPI:1003917675
Name:PODIATRY ASSOCIATES OF FLORIDA INC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF FLORIDA INC
Other - Org Name:PODIATRY ASSOCIATES OF NORTHEAST FLORIDA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORPORATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-224-2001
Mailing Address - Street 1:3117 SPRING GLEN RD
Mailing Address - Street 2:STE 402
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5906
Mailing Address - Country:US
Mailing Address - Phone:904-224-2001
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:1824 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1904
Practice Address - Country:US
Practice Address - Phone:904-224-2001
Practice Address - Fax:904-224-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI4974OtherRAILROAD MEDICARE
CN7422OtherRAILROAD MEDICARE
DC3124OtherRAILROAD MEDICARE
65047OtherBLUE CROSS BLUE SHIELD
480025470OtherRAILROAD MEDICARE
21698IMedicare PIN
DC3124OtherRAILROAD MEDICARE
65809OtherBLUE CROSS BLUE SHIELD