Provider Demographics
NPI:1649745886
Name:ANKLE & FOOT CENTER OF TAMPA BAY
Entity Type:Organization
Organization Name:ANKLE & FOOT CENTER OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-254-4747
Mailing Address - Street 1:2835 W DE LEON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:813-254-4747
Mailing Address - Fax:813-254-8262
Practice Address - Street 1:801 S FLORIDA AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5242
Practice Address - Country:US
Practice Address - Phone:863-606-1147
Practice Address - Fax:863-608-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID