Provider Demographics
NPI:1669657524
Name:OCALA PODIATRY CENTER
Entity Type:Organization
Organization Name:OCALA PODIATRY CENTER
Other - Org Name:OCALA PODIATRY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-867-1155
Mailing Address - Street 1:2135 SW 19TH AVENUE RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7874
Mailing Address - Country:US
Mailing Address - Phone:352-867-1155
Mailing Address - Fax:352-867-7030
Practice Address - Street 1:2135 SW 19TH AVENUE RD
Practice Address - Street 2:SUITE #104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7874
Practice Address - Country:US
Practice Address - Phone:352-867-1155
Practice Address - Fax:352-867-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2144213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCC8499OtherRR MEDICARE
FLU10305Medicare UPIN
FLCC8499OtherRR MEDICARE