Provider Demographics
NPI:1184000556
Name:PODIATRY NETWORK SOLUTIONS OF FLORIDA, LLC
Entity Type:Organization
Organization Name:PODIATRY NETWORK SOLUTIONS OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-284-7484
Mailing Address - Street 1:8323 NW 12TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1829
Mailing Address - Country:US
Mailing Address - Phone:305-284-7484
Mailing Address - Fax:305-667-8860
Practice Address - Street 1:8323 NW 12TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1829
Practice Address - Country:US
Practice Address - Phone:305-284-7484
Practice Address - Fax:305-667-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherSPECIALTY NETWORK