Space Coast Podiatry LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

SPACE COAST PODIATRY LLC

Practice address

6100 Minton Rd NW Ste 101
Palm Bay, FL 32907-1900

Phone

(321) 802-4075

NPI assigned

Apr 30, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Mark Allen Vaughn, DPMNPI 1477948917

Title

Ceo/Physician

Phone

(321) 802-4075

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Vaughn, DPM

  • Foot & Ankle Surgery Podiatrist
  • Palm Bay, FL
  • NPI 1477948917
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1740037597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 MINTON RD NW STE 101",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071900",
            "telephone_number": "321-802-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 MINTON RD NW STE 101",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329071900",
            "telephone_number": "321-802-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO/PHYSICIAN",
        "authorized_official_telephone_number": "321-802-4075",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Space Coast Chiropractic & Acupuncture
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• Space Coast Hospitalists LLC
• Space Coast Medical Management LLC
• Space Coast Neurology and Pain Management PA
• Space Coast Total Health Care
• Spacecoast Wound Specialist LLC
• Beverley W. Spalding, ARNP
• James Spanogle
• Specialized Treatment, Education and Prevention Services Inc.

• Foot & Ankle Surgery Podiatrist in Palm Bay, FL
• Providers in Palm Bay, 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 Sep 9, 2024; 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.