Provider Demographics
NPI:1053849349
Name:SAINT LUCIE FOOT & ANKLE CENTRE, INC
Entity Type:Organization
Organization Name:SAINT LUCIE FOOT & ANKLE CENTRE, INC
Other - Org Name:SAINT LUCIE FOOT & ANKLE CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-800-5811
Mailing Address - Street 1:1696 SE HILLMOOR DR STE A
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7699
Mailing Address - Country:US
Mailing Address - Phone:772-800-5811
Mailing Address - Fax:
Practice Address - Street 1:1696 SE HILLMOOR DR STE A
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-800-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3910213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty