Provider Demographics
NPI:1457544025
Name:SAMMY & DIVINCENZO, P.A.
Entity Type:Organization
Organization Name:SAMMY & DIVINCENZO, P.A.
Other - Org Name:ELLENTON FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-753-1234
Mailing Address - Street 1:7210 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3444
Mailing Address - Country:US
Mailing Address - Phone:941-753-1234
Mailing Address - Fax:941-755-1332
Practice Address - Street 1:7210 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3444
Practice Address - Country:US
Practice Address - Phone:941-729-5588
Practice Address - Fax:941-729-0012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADENTON PODIATRY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1826213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF1471OtherRAIL ROAD MEDICARE
FLCF1471OtherRAIL ROAD MEDICARE