Healthcare Provider Details

I. General information

NPI: 1922747146
Provider Name (Legal Business Name): SOUTH FLORIDA LOWER EXTREMITY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 PGA BLVD STE 101
PALM BEACH GARDENS FL
33418-3829
US

IV. Provider business mailing address

5602 PGA BLVD STE 101
PALM BEACH GARDENS FL
33418-3829
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-6444
  • Fax:
Mailing address:
  • Phone: 561-627-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CASON M. QUINN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DPM
Phone: 561-320-1248