Provider Demographics
NPI:1073231353
Name:IHN PODIATRY SERVICES PLLC
Entity Type:Organization
Organization Name:IHN PODIATRY SERVICES PLLC
Other - Org Name:BEDSIDE WOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIED
Authorized Official - Middle Name:
Authorized Official - Last Name:EBSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-781-9667
Mailing Address - Street 1:5304 S FLORIDA AVE STE 400F
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4914
Mailing Address - Country:US
Mailing Address - Phone:863-738-6601
Mailing Address - Fax:
Practice Address - Street 1:5304 S FLORIDA AVE STE 400F
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4914
Practice Address - Country:US
Practice Address - Phone:863-738-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116891200Medicaid