Healthcare Provider Details

I. General information

NPI: 1649844804
Provider Name (Legal Business Name): GENESIS FOOT AND ANKLE INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 N CONGRESS AVE STE 101
WEST PALM BEACH FL
33407-3381
US

IV. Provider business mailing address

4601 N CONGRESS AVE STE 101
WEST PALM BEACH FL
33407-3381
US

V. Phone/Fax

Practice location:
  • Phone: 561-812-3762
  • Fax: 561-812-3763
Mailing address:
  • Phone: 561-812-3762
  • Fax: 561-812-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SONIA HANKERSON
Title or Position: MANAGER
Credential:
Phone: 545-999-5379