=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366626541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEATON PODIATRY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2007
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6707 38TH AVE N
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33710-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-896-4615
-----------------------------------------------------
Fax | 727-256-3855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6707 38TH AVE N
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33710-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-896-4615
-----------------------------------------------------
Fax | 727-896-4616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | LISA MERKOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-800-9958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------