Provider Demographics
NPI:1710995733
Name:PREMIER FOOT AND ANKLE SPECIALISTS PA
Entity Type:Organization
Organization Name:PREMIER FOOT AND ANKLE SPECIALISTS PA
Other - Org Name:PREMIER FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-873-6065
Mailing Address - Street 1:4120 WOODMERE PARK BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5373
Mailing Address - Country:US
Mailing Address - Phone:941-488-0222
Mailing Address - Fax:941-480-1668
Practice Address - Street 1:4120 WOODMERE PARK BLVD STE 5
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5373
Practice Address - Country:US
Practice Address - Phone:941-488-0222
Practice Address - Fax:941-480-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1580213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041248100Medicaid
FL74640OtherGROUP BCBS
FL041248100Medicaid
FL74640OtherGROUP BCBS
FL74640OtherGROUP BCBS
FL041248100Medicaid
FL1307950001Medicare NSC
FL87840EMedicare PIN