O W S Medical, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

O W S MEDICAL, LLC

Doing business as

Mid Lake Foot and Ankle

Practice address

870 S Duncan Dr
Tavares, FL 32778-4044

Phone

(352) 432-8434

NPI assigned

Apr 16, 2020

Last updated

Apr 16, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Breanna J. FergusonNPI 1114304425

Title

Owner

Phone

(352) 432-8434

Specialties & licenses 1

Addresses

Other names 1

• Mid Lake Foot and Ankle Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• O W S Medical LLC

  • Podiatrist
  • Tavares, FL
  • NPI 1669931770

  6103169834

  Same PAC ID

Tax ID family

O W S Medical LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• O W S Medical LLC

  • Podiatrist
  • Tavares, FL
  • NPI 1669931770
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Breanna J. Ferguson, D.P.M.

  • Podiatrist
  • Tavares, FL
  • NPI 1114304425
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586995200000",
    "number": "1578182895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 S DUNCAN DR",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 S DUNCAN DR",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784044",
            "telephone_number": "352-432-8434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O W S MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-16",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "BREANNA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-432-8434"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Lake Foot and Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yen Nhi Nguyet Nguyen, PHARMD
• Elefterios T Nikolaidis, M.D.
• Peter Douglas Nordstrom, LMHC
• Brian Null, PTA
• O W S Medical LLC
• Christopher Nathan O'Bryan, MSW, RCSWI
• Devlin O'Connor, D.O.
• Erin Catherine O'Connor, MS
• Melissa Ogden, APRN
• Dana Marie Oldham, D.O.

• Foot & Ankle Surgery Podiatrist in Tavares, FL
• Providers in Tavares, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.