Provider Demographics
NPI:1417137183
Name:PODIATRY ASSOCIATES OF FLORIDA INC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF FLORIDA INC
Other - Org Name:PODIATRY ASSOCIATES OF NORTHEAST FLORIDA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORPORATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-251-5053
Mailing Address - Street 1:5911 TIMUQUANA RD UNIT 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7897
Mailing Address - Country:US
Mailing Address - Phone:904-251-5053
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:5911 TIMUQUANA RD UNIT 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7897
Practice Address - Country:US
Practice Address - Phone:904-251-5053
Practice Address - Fax:904-224-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65490OtherBLUE CROSS BLUE SHIELD
FLCI4974OtherRAILROAD MEDICARE
480030919OtherRAILROAD MEDICARE
65967OtherBLUE CROSS BLUE SHIELD
P00442507OtherRAILROAD MEDICARE
480026736OtherRAILROAD MEDICARE
87629OtherBLUE CROSS BLUE SHIELD
FLCI4974OtherRAILROAD MEDICARE