Provider Demographics
NPI:1669478202
Name:SARASOTA FOOT CARE CENTER PA
Entity Type:Organization
Organization Name:SARASOTA FOOT CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-917-6232
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:STE 106
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2941
Mailing Address - Country:US
Mailing Address - Phone:941-917-6232
Mailing Address - Fax:941-917-7231
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:STE 106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-917-6232
Practice Address - Fax:941-917-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21570213E00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21570Medicare PIN
FL3888670001Medicare NSC