Provider Demographics
NPI:1689151011
Name:ON-SITE FOOT CARE INC
Entity Type:Organization
Organization Name:ON-SITE FOOT CARE INC
Other - Org Name:ON-SITE FOOT CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:METNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-455-4108
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-1225
Mailing Address - Country:US
Mailing Address - Phone:727-455-4108
Mailing Address - Fax:
Practice Address - Street 1:422 APPALOOSA RD
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-9060
Practice Address - Country:US
Practice Address - Phone:727-999-1823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-28
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340259200Medicaid