Provider Demographics
NPI:1821051962
Name:TALLAHASSEE PODIATRY ASSOCIATES PA
Entity Type:Organization
Organization Name:TALLAHASSEE PODIATRY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-6998
Mailing Address - Street 1:1866 BUFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4442
Mailing Address - Country:US
Mailing Address - Phone:850-878-6998
Mailing Address - Fax:850-656-9293
Practice Address - Street 1:1866 BUFORD BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4442
Practice Address - Country:US
Practice Address - Phone:850-878-6998
Practice Address - Fax:850-656-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340098100Medicaid
FL340098105Medicaid
FL340098104Medicaid