Provider Demographics
NPI:1609981083
Name:JUPITER FOOT AND ANKLE PA
Entity Type:Organization
Organization Name:JUPITER FOOT AND ANKLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGINIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-741-4900
Mailing Address - Street 1:651 W INDIANTOWN ROAD
Mailing Address - Street 2:SUITE K
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-741-4900
Mailing Address - Fax:561-741-4918
Practice Address - Street 1:651 W INDIANTOWN ROAD
Practice Address - Street 2:SUITE K
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-741-4900
Practice Address - Fax:561-741-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2828213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3402606-00Medicaid
U84408Medicare UPIN
FLE53052Medicare ID - Type Unspecified
FL4413230001Medicare NSC