Provider Demographics
NPI:1134158264
Name:SOUTHERNMOST FOOT AND ANKLE SPECIALISTS PA
Entity type:Organization
Organization Name:SOUTHERNMOST FOOT AND ANKLE SPECIALISTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-235-9550
Mailing Address - Street 1:381 N KROME AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6047
Mailing Address - Country:US
Mailing Address - Phone:305-246-4774
Mailing Address - Fax:305-248-4086
Practice Address - Street 1:381 N KROME AVE STE 112
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6047
Practice Address - Country:US
Practice Address - Phone:305-246-4774
Practice Address - Fax:305-248-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270007700Medicaid
FL390443100Medicaid
FL340494300Medicaid
FL390384200Medicaid
FL390458000Medicaid
FL340211800Medicaid
FL340494300Medicaid
FLE1272ZMedicare PIN
FL270007700Medicaid
FL97752Medicare PIN
FLU72304Medicare UPIN
FL340211800Medicaid
FL390384200Medicaid
FLU79371Medicare UPIN
FLU69814Medicare UPIN
FL390443100Medicaid
FL65545ZMedicare PIN
FL03012ZMedicare PIN