Provider Demographics
NPI:1992939730
Name:NORTH FLORIDA ORTHOTICS
Entity type:Organization
Organization Name:NORTH FLORIDA ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPED,CPED,ORF
Authorized Official - Phone:352-377-7003
Mailing Address - Street 1:5000 NW 34TH ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1188
Mailing Address - Country:US
Mailing Address - Phone:352-377-7003
Mailing Address - Fax:352-377-5703
Practice Address - Street 1:5000 NW 34TH ST
Practice Address - Street 2:UNIT 1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1188
Practice Address - Country:US
Practice Address - Phone:352-377-7003
Practice Address - Fax:352-377-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001306000Medicaid
6262020001Medicare NSC