Provider Demographics
NPI:1851578918
Name:SCOTT P KURECKI DPM PA
Entity Type:Organization
Organization Name:SCOTT P KURECKI DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KURECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-426-1167
Mailing Address - Street 1:12757 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1934
Mailing Address - Country:US
Mailing Address - Phone:941-426-1167
Mailing Address - Fax:941-426-2571
Practice Address - Street 1:12757 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1934
Practice Address - Country:US
Practice Address - Phone:941-426-1167
Practice Address - Fax:941-426-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP1100X
FLPO0001946332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN7786OtherMEDICARE EDI SENDER
FL029759300Medicaid
FL480007561OtherRAILROAD MEDICARE
FL480007561OtherRAILROAD MEDICARE
FLDD203AMedicare PIN
FLBK1421659OtherDEA NUMBER
FL480007561OtherRAILROAD MEDICARE