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NPI Code Detail

MEDICARE: PREMIER FOOT AND ANKLE

MEDICARE: PREMIER FOOT AND ANKLE
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
1213E00000XPodiatrist

Other Identifiers

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

General Provider Information

NPI Number : 1356943963
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER FOOT AND ANKLE
Provider Business Mailing Address
First Line : 401 E JACKSON ST STE 2340
Second Line :
City : TAMPA
State : FL
Zip : 33602-5226
Country : US
Telephone Number : 813-751-2291
Fax Number : 813-751-2294
Provider Business Practice Location Address
First Line : 401 E JACKSON ST STE 2340
Second Line :
City : TAMPA
State : FL
Zip : 33602-5226
Country : US
Telephone Number : 813-751-2291
Fax Number : 813-751-2294
Authorized Official
Title or Position : CEO
Name : DR. TOMMY STEVEN KENNEDY
Credential : DPM
Telephone Number : 813-751-2291
Provider Enumeration Date : 11/10/2020
Last Update Date : 11/12/2020

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Directions to “PREMIER FOOT AND ANKLE ” Practice Location

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