Provider Demographics
NPI:1093084642
Name:SCOLA PODIATRY P A
Entity Type:Organization
Organization Name:SCOLA PODIATRY P A
Other - Org Name:JERE SCOLA III DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-264-0094
Mailing Address - Street 1:2630 NW 41ST ST
Mailing Address - Street 2:SUITE C3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7495
Mailing Address - Country:US
Mailing Address - Phone:352-375-0166
Mailing Address - Fax:352-375-1677
Practice Address - Street 1:4615 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4885
Practice Address - Country:US
Practice Address - Phone:352-264-0094
Practice Address - Fax:352-375-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02981261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340266500Medicaid
FL65754Medicare PIN