Provider Demographics
NPI:1679777668
Name:PODIATRY ASSOCIATES OF FLORIDA INC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF FLORIDA INC
Other - Org Name:PODIATRY ASSOCIATES OF NORTHEAST FLORIDA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORPORATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SINCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-224-2001
Mailing Address - Street 1:3117 SPRING GLEN RD
Mailing Address - Street 2:STE 402
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5906
Mailing Address - Country:US
Mailing Address - Phone:904-224-2001
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:320 DUNDAS DR
Practice Address - Street 2:STE 7-8
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8502
Practice Address - Country:US
Practice Address - Phone:904-757-4523
Practice Address - Fax:904-726-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-01121213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
48002574OtherRAILROAD MEDICARE
DA0704OtherRAILROAD MEDICARE
87606OtherBLUE CROSS BLUE SHIELD
CI4974OtherRAILROAD MEDICARE
P00008626OtherRAILROAD MEDICARE
65770OtherBLUE CROSS BLUE SHIELD
48002574OtherRAILROAD MEDICARE