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Organization

NATURE COAST FOOT AND ANKLE CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENNETH P PRITCHYK D.P.M. (OWNER)
(352) 563-5488
Entity
Organization

Contact information

Practice address
6254 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8723
(352) 228-4975
(352) 228-4977
Mailing address
PO BOX 2319, CRYSTAL RIVER, FL 34423-2319
(352) 228-4975
(352) 228-4977

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
004KU
FLORIDA BLUE
FL
05
009044800
FL
01
6980350001
DMEPOS
FL
Enumeration date
07/02/2013
Last updated
02/13/2014
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