Provider Demographics
NPI:1356367858
Name:NORTH FLORIDA FAMILY PODIATRY
Entity type:Organization
Organization Name:NORTH FLORIDA FAMILY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:ORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-362-2555
Mailing Address - Street 1:PO BOX 358870
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8870
Mailing Address - Country:US
Mailing Address - Phone:386-362-2555
Mailing Address - Fax:386-362-2557
Practice Address - Street 1:609 5TH STREET SW
Practice Address - Street 2:SUITE 4
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2239
Practice Address - Country:US
Practice Address - Phone:386-362-2555
Practice Address - Fax:352-362-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4517250001Medicare NSC
FLAY735Medicare PIN