Provider Demographics
NPI:1316054513
Name:PREMIER FOOT AND ANKLE SPECIALISTS
Entity type:Organization
Organization Name:PREMIER FOOT AND ANKLE SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-582-6082
Mailing Address - Street 1:712 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3524
Mailing Address - Country:US
Mailing Address - Phone:941-488-0222
Mailing Address - Fax:941-480-1668
Practice Address - Street 1:414 N BREVARD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-4504
Practice Address - Country:US
Practice Address - Phone:863-494-3478
Practice Address - Fax:863-494-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1580213E00000X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041248100Medicaid
T84659Medicare UPIN
FL87840XMedicare PIN
FL1297240001Medicare NSC
FL041248100Medicaid