Provider Demographics
NPI:1851788418
Name:ORLANDO FOOT AND ANKLE CLINIC, INC
Entity Type:Organization
Organization Name:ORLANDO FOOT AND ANKLE CLINIC, INC
Other - Org Name:ORLANDO FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-423-1234
Mailing Address - Street 1:3165 MCCRORY PL STE 174
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3727
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:
Practice Address - Street 1:3650 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6736
Practice Address - Country:US
Practice Address - Phone:352-366-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029602300Medicaid
FL77337Medicare PIN