Provider Demographics
NPI:1760495162
Name:ANKLE & FOOT CENTRE OF S FLORIDA PA
Entity type:Organization
Organization Name:ANKLE & FOOT CENTRE OF S FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-798-0900
Mailing Address - Street 1:13005 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9272
Mailing Address - Country:US
Mailing Address - Phone:561-798-0900
Mailing Address - Fax:561-798-1121
Practice Address - Street 1:13005 SOUTHERN BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9272
Practice Address - Country:US
Practice Address - Phone:561-798-0900
Practice Address - Fax:561-798-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74986Medicare ID - Type UnspecifiedAFCFS
FL65294ZMedicare ID - Type UnspecifiedJEFFREY BLANK, DPM
FL5608690001Medicare NSC
FL65293ZMedicare ID - Type UnspecifiedDOROTHY BLANK, DPM