MEDICARE: NORTH FLORIDA FOOT & ANKLE CENTER PA

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	213ES0000X	Sports Medicine Podiatrist
2	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

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

General Provider Information

NPI Number	:	1548305923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA FOOT & ANKLE CENTER PA

Provider Business Mailing Address
First Line	:	465 TOWN PLAZA AVE STE A
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5164
Country	:	US
Telephone Number	:	904-236-5023
Fax Number	:	904-236-5073

Provider Business Practice Location Address
First Line	:	465 TOWN PLAZA AVE STE A
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5164
Country	:	US
Telephone Number	:	904-236-5023
Fax Number	:	904-236-5073

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW K BARTELL
Credential	:	DPM
Telephone Number	:	904-236-5023

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	01/28/2022

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