Provider Demographics
NPI:1467034652
Name:NORTH FLORIDA FOOT CLINIC PLLC
Entity Type:Organization
Organization Name:NORTH FLORIDA FOOT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JASON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-725-2121
Mailing Address - Street 1:3600 CRILL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-8112
Mailing Address - Country:US
Mailing Address - Phone:386-325-7541
Mailing Address - Fax:386-325-7204
Practice Address - Street 1:3600 CRILL AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-8112
Practice Address - Country:US
Practice Address - Phone:386-325-7541
Practice Address - Fax:386-325-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty