Provider Demographics
NPI:1821406679
Name:FLAGLER FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:FLAGLER FAMILY MEDICINE PA
Other - Org Name:NORTHEAST FLORIDA FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SATKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-547-2808
Mailing Address - Street 1:130 HEALTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5776
Mailing Address - Country:US
Mailing Address - Phone:904-547-2808
Mailing Address - Fax:904-679-3169
Practice Address - Street 1:315 W TOWN PL STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3105
Practice Address - Country:US
Practice Address - Phone:904-429-4736
Practice Address - Fax:904-679-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252488100Medicaid
FL21203Medicare PIN