MEDICARE: BAYSHORE PODIATRY CENTER

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		FL
2	261QP1100X	Podiatric Clinic/Center
3	213E00000X	Podiatrist	P00001221	FL
4	213ES0000X	Sports Medicine Podiatrist		FL

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	:	1982688354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE PODIATRY CENTER

Provider Business Mailing Address
First Line	:	508 S HABANA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4161
Country	:	US
Telephone Number	:	813-877-6636
Fax Number	:	813-877-6610

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4161
Country	:	US
Telephone Number	:	813-877-6636
Fax Number	:	813-877-6610

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES EDWARD REPKO
Credential	:	DPM
Telephone Number	:	813-877-6636

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/23/2024

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Directions to “BAYSHORE PODIATRY CENTER ” Practice Location

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