Provider Demographics
NPI:1265663777
Name:KRISTI L CONWAY DPM PA
Entity Type:Organization
Organization Name:KRISTI L CONWAY DPM PA
Other - Org Name:BAY AREA PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-685-3668
Mailing Address - Street 1:1149 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4887
Mailing Address - Country:US
Mailing Address - Phone:813-685-3668
Mailing Address - Fax:813-685-5430
Practice Address - Street 1:1149 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4887
Practice Address - Country:US
Practice Address - Phone:813-685-3668
Practice Address - Fax:813-685-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6307270001Medicare NSC
FLCE009AMedicare PIN