Provider Demographics
NPI:1659394906
Name:MOBILE PODIATRY SERVICES INC
Entity Type:Organization
Organization Name:MOBILE PODIATRY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:VERLENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-968-2328
Mailing Address - Street 1:5330 WINHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5330 WINHAWK WAY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8038
Practice Address - Country:US
Practice Address - Phone:813-968-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF3492OtherRRMC
FL340432300Medicaid
FLU2030XMedicare PIN
FLK9228Medicare PIN