MEDICARE: PODIATRY ASSOCIATES OF FLORIDA INC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	CI4974	OTHER	RAILROAD MEDICARE
2	CN7422	OTHER	RAILROAD MEDICARE
3	DC3124	OTHER	RAILROAD MEDICARE
5	480025470	OTHER	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	65047	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1003917675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY ASSOCIATES OF FLORIDA INC

Provider Business Mailing Address
First Line	:	3117 SPRING GLEN RD
Second Line	:	STE 402
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5906
Country	:	US
Telephone Number	:	904-224-2001
Fax Number	:	904-224-2002

Provider Business Practice Location Address
First Line	:	1824 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-1904
Country	:	US
Telephone Number	:	904-224-2001
Fax Number	:	904-224-2002

Authorized Official
Title or Position	:	CORPORATE ADMINISTRATOR
Name	:	JEANNIE M BASKIN
Credential	:
Telephone Number	:	904-224-2001

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	05/26/2017

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Directions to “PODIATRY ASSOCIATES OF FLORIDA INC ” Practice Location

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