Provider Demographics
NPI:1841378981
Name:V C PODIATRY PA
Entity Type:Organization
Organization Name:V C PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-881-9118
Mailing Address - Street 1:1735 BRANDON TRACE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2027
Mailing Address - Country:US
Mailing Address - Phone:813-881-9118
Mailing Address - Fax:
Practice Address - Street 1:1735 BRANDON TRACE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2027
Practice Address - Country:US
Practice Address - Phone:813-881-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2083213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340200200Medicaid
FLU17506Medicare UPIN
FL340200200Medicaid