Provider Demographics
NPI:1548305923
Name:NORTH FLORIDA FOOT & ANKLE CENTER PA
Entity type:Organization
Organization Name:NORTH FLORIDA FOOT & ANKLE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-236-5023
Mailing Address - Street 1:465 TOWN PLAZA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5164
Mailing Address - Country:US
Mailing Address - Phone:904-236-5023
Mailing Address - Fax:904-236-5073
Practice Address - Street 1:465 TOWN PLAZA AVE STE A
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5164
Practice Address - Country:US
Practice Address - Phone:904-236-5023
Practice Address - Fax:904-236-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340474900Medicaid
FLDF9861Medicare PIN
FLP00681611Medicare PIN
FLV02842Medicare UPIN
FLU3054YMedicare PIN
FL340474900Medicaid
V01111Medicare UPIN
FLP00407506Medicare PIN
FL5878030001Medicare NSC
65838YMedicare PIN