Provider Demographics
NPI:1568785012
Name:SCOLA PODIATRY
Entity Type:Organization
Organization Name:SCOLA PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOLA
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-264-0094
Mailing Address - Street 1:PO BOX 147050
Mailing Address - Street 2:PMB 515
Mailing Address - City:GAIENSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-4885
Mailing Address - Country:US
Mailing Address - Phone:352-264-0094
Mailing Address - Fax:352-375-1677
Practice Address - Street 1:4615 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4885
Practice Address - Country:US
Practice Address - Phone:352-264-0094
Practice Address - Fax:352-375-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02981213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340266500Medicaid
FL340266500Medicaid