Provider Demographics
NPI:1558661801
Name:NAOMI S MARSH P A
Entity Type:Organization
Organization Name:NAOMI S MARSH P A
Other - Org Name:AT HOME FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-960-2888
Mailing Address - Street 1:PO BOX 272634
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-2634
Mailing Address - Country:US
Mailing Address - Phone:813-960-2888
Mailing Address - Fax:
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD
Practice Address - Street 2:#206
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1356
Practice Address - Country:US
Practice Address - Phone:813-960-2888
Practice Address - Fax:813-925-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029639200Medicaid
FLT88577Medicare UPIN