Provider Demographics
NPI:1942315171
Name:SEBRING PODIATRY CENTER INC
Entity Type:Organization
Organization Name:SEBRING PODIATRY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-314-8600
Mailing Address - Street 1:6801 US HIGHWAY 27 N
Mailing Address - Street 2:STE D3
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7840
Mailing Address - Country:US
Mailing Address - Phone:863-314-8600
Mailing Address - Fax:863-314-8556
Practice Address - Street 1:6801 US HIGHWAY 27 N
Practice Address - Street 2:STE D3
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-314-8600
Practice Address - Fax:863-314-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2915213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC2709OtherRAILROAD MEDICARE
FL74758OtherBLUE CROSS BLUE SHIELD
FLK2786Medicare PIN
FL5013930001Medicare NSC
FL74758OtherBLUE CROSS BLUE SHIELD