Provider Demographics
NPI:1922269984
Name:DSM MANAGEMENT CORPORATION OF NORTHEAST FLORIDA INC
Entity Type:Organization
Organization Name:DSM MANAGEMENT CORPORATION OF NORTHEAST FLORIDA INC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:904-230-8229
Mailing Address - Street 1:585 STATE ROAD 13 NORTH
Mailing Address - Street 2:#100
Mailing Address - City:FRUIT COVE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3175
Mailing Address - Country:US
Mailing Address - Phone:904-230-8229
Mailing Address - Fax:904-230-8219
Practice Address - Street 1:585 STATE ROAD 13 NORTH
Practice Address - Street 2:#100
Practice Address - City:FRUIT COVE
Practice Address - State:FL
Practice Address - Zip Code:32259-3175
Practice Address - Country:US
Practice Address - Phone:904-230-8229
Practice Address - Fax:904-230-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED151335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6053350001Medicare NSC