Provider Demographics
NPI:1801829197
Name:FAMILY PODIATRY CENTERS OF ST PODIATRY, P.L.
Entity type:Organization
Organization Name:FAMILY PODIATRY CENTERS OF ST PODIATRY, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-321-5678
Mailing Address - Street 1:5027 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8240
Mailing Address - Country:US
Mailing Address - Phone:727-321-5678
Mailing Address - Fax:727-321-5788
Practice Address - Street 1:5027 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8240
Practice Address - Country:US
Practice Address - Phone:727-321-5678
Practice Address - Fax:727-321-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2943213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU86403Medicare UPIN