Provider Demographics
NPI:1982756706
Name:ADVANCED PODIATRY PA
Entity Type:Organization
Organization Name:ADVANCED PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-971-4678
Mailing Address - Street 1:2919 W SWANN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4050
Mailing Address - Country:US
Mailing Address - Phone:813-875-0555
Mailing Address - Fax:866-313-3106
Practice Address - Street 1:2919 W SWANN AVE STE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4050
Practice Address - Country:US
Practice Address - Phone:813-875-0555
Practice Address - Fax:866-313-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2475OtherMEDICARE GROUP PTAN
FL004C8OtherBCBS GROUP NUMBER
FL008390800OtherMEDICAID GROUP NUMBER
FLK8186Medicare PIN
FL5574820001Medicare NSC
FL5574820001Medicare NSC