NPIMap

Organization Active NPI

Palm Podiatry, LLC

  • Foot & Ankle Surgery Podiatrist
  • Fort Myers, FL
National Provider Identifier
1982662201
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO1528 Issued in FL
Legal business name
PALM PODIATRY, LLC
Practice address
15620 McGregor Blvd
Suite E
Fort Myers, FL 33908-2528
Phone
(239) 433-0064
Fax
(239) 433-0224
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Miss Ruthann Park, PRT, PMAC
Title
Practice Adminisrtator
Phone
(239) 433-0064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO1528 FL Primary

Addresses

Primary practice location

15620 McGregor Blvd
Suite E
Fort Myers, FL 33908-2528

Mailing address

15620 McGregor Blvd
Suite E
Fort Myers, FL 33908-2528
Phone (239) 433-0064

National Provider Directory

National Provider Directory

Locations

15620 McGregor Blvd
Ste E
Fort Myers, FL 33908
Phone (239) 433-0064

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982662201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15620 MCGREGOR BLVD",
            "address_2": "SUITE E",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339082528",
            "telephone_number": "239-433-0064",
            "fax_number": "239-433-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 MCGREGOR BLVD",
            "address_2": "SUITE E",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339082528",
            "telephone_number": "239-433-0064",
            "fax_number": "239-433-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "RUTHANN",
        "authorized_official_title_or_position": "PRACTICE ADMINISRTATOR",
        "authorized_official_telephone_number": "239-433-0064",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PRT, PMAC"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO1528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.