Provider Demographics
NPI:1396287884
Name:TRI COUNTY PODIATRY P A
Entity type:Organization
Organization Name:TRI COUNTY PODIATRY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-259-1919
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-259-1919
Mailing Address - Fax:352-259-2042
Practice Address - Street 1:340 HEALD WAY
Practice Address - Street 2:BLDG 100
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6087
Practice Address - Country:US
Practice Address - Phone:352-259-1919
Practice Address - Fax:352-259-2042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY PODIATRY P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty