Provider Demographics
NPI:1033296173
Name:INSTITUTE FOR FOOT AND ANKLE SURGERY
Entity Type:Organization
Organization Name:INSTITUTE FOR FOOT AND ANKLE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ADAOBI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-774-2200
Mailing Address - Street 1:955 TOWN CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8255
Mailing Address - Country:US
Mailing Address - Phone:386-774-2200
Mailing Address - Fax:867-742-2202
Practice Address - Street 1:955 TOWN CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8255
Practice Address - Country:US
Practice Address - Phone:386-774-2200
Practice Address - Fax:386-774-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3038213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65870OtherBCBS
FL340410200Medicaid
FL=========OtherGHI
FL=========OtherUNITED HEALTH CARE
FL=========OtherPHCS
FL=========OtherGEHA
FL=========OtherMULTIPLAN
FL=========OtherSOUTHCARE
FL=========OtherAMERIGROUP
FL=========OtherCITRUS HEALTHCARE
FL=========OtherHUMANA
FL=========OtherTRICARE
FL=========OtherBEECHSTREET
FL=========OtherEVOLUTIONS
FL=========OtherFMHN
FL=========OtherFIRST HEALTH
FL=========OtherTRICARE
FL=========OtherBEECHSTREET