MEDICARE: PODIATRY & BAREFOOT WELLNESS CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578696878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY & BAREFOOT WELLNESS CENTERS LLC

Provider Business Mailing Address
First Line	:	1205 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3405
Country	:	US
Telephone Number	:	904-389-0346
Fax Number	:	904-246-5449

Provider Business Practice Location Address
First Line	:	1205 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3405
Country	:	US
Telephone Number	:	904-389-0346
Fax Number	:	904-246-5449

Authorized Official
Title or Position	:	PRESIDENT DIRECTOR
Name	:	DR. HOWARD J GROSHELL
Credential	:	DPM
Telephone Number	:	904-389-0346

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	11/19/2013

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