Provider Demographics
NPI:1588634968
Name:CITRUS PODIATRY CENTER PA
Entity type:Organization
Organization Name:CITRUS PODIATRY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-746-0077
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-1120
Mailing Address - Country:US
Mailing Address - Phone:352-746-0077
Mailing Address - Fax:352-746-1704
Practice Address - Street 1:2385 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-746-0077
Practice Address - Fax:352-746-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21424Medicare PIN
FL0607410001Medicare NSC