Provider Demographics
NPI:1407218092
Name:FOUNDATIONS FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:FOUNDATIONS FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-650-9573
Mailing Address - Street 1:22319 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-5705
Mailing Address - Country:US
Mailing Address - Phone:352-650-9573
Mailing Address - Fax:513-858-7827
Practice Address - Street 1:22319 POWELL RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-5705
Practice Address - Country:US
Practice Address - Phone:352-650-9573
Practice Address - Fax:513-858-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3695213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018641900Medicaid
FLIO229AMedicare PIN
FLDW6252Medicare PIN