MEDICARE: SOUTH FLORIDA LOWER EXTREMITY INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	261QM2500X	Medical Specialty Clinic/Center
3	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	:	1922747146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA LOWER EXTREMITY INSTITUTE LLC

Provider Business Mailing Address
First Line	:	5602 PGA BLVD STE 101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3829
Country	:	US
Telephone Number	:	561-627-6444
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 PGA BLVD STE 101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3829
Country	:	US
Telephone Number	:	561-627-6444
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. CASON M. QUINN
Credential	:	DPM
Telephone Number	:	561-320-1248

Provider Enumeration Date	:	06/04/2022
Last Update Date	:	06/22/2022

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