Provider Demographics
NPI:1265458350
Name:TRI COUNTY PODIATRY PA
Entity Type:Organization
Organization Name:TRI COUNTY PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-259-1919
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-259-1919
Mailing Address - Fax:352-259-2042
Practice Address - Street 1:1585 SANTA BARBARA BLVD
Practice Address - Street 2:STE B
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6820
Practice Address - Country:US
Practice Address - Phone:352-259-1919
Practice Address - Fax:352-259-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2795213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL193665OtherFIRST HEALTH NETWORK
FLDE3612OtherRAILROAD
FL65623OtherBCBS
FL193665OtherFIRST HEALTH NETWORK
FLK9216Medicare ID - Type UnspecifiedTRICOUNTY PODIATRY GROUP#
FL=========OtherUNITED HEALTH CARE
FL65623OtherBCBS