Provider Demographics
NPI:1659795748
Name:NORTH FLORIDA ORTHOTIC COMPANY INC
Entity Type:Organization
Organization Name:NORTH FLORIDA ORTHOTIC COMPANY INC
Other - Org Name:NORTH FLORIDA ORTHOTIC COMPANY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLA
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-377-7003
Mailing Address - Street 1:4615 NW 53RD AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4885
Mailing Address - Country:US
Mailing Address - Phone:352-377-7003
Mailing Address - Fax:352-377-5703
Practice Address - Street 1:2441 NW 43RD STREET
Practice Address - Street 2:SUITE 2D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-377-7003
Practice Address - Fax:352-377-5703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH FLORIDA ORTHOTIC COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED157335E00000X
FLORT89335E00000X
FLORF82335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier