| Superior Podiatry, Llc | |
|
1690 Us Highway 1 S Ste C, Saint Augustine, FL 32084-6024 | |
| (904) 436-8001 | |
| (904) 377-6776 |
| Full Name | Superior Podiatry, Llc |
|---|---|
| Type | Facility |
| Speciality | Podiatrist - Foot & Ankle Surgery |
| Location | 1690 Us Highway 1 S Ste C, Saint Augustine, Florida |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457839839 | NPI | - | NPPES |
| 101522100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | (* (Not Available)) | Secondary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (* (Not Available)) | Primary |
| Provider Name | John R Northrup |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1891178406 PECOS PAC ID: 7113266636 Enrollment ID: I20190228000511 |
| Provider Name | Nicole C Gortaire |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1174148613 PECOS PAC ID: 3678995875 Enrollment ID: I20230707001903 |
| Mailing Address | Practice Location Address |
|---|---|
| Superior Podiatry, Llc 1690 Us Highway 1 S Ste C, Saint Augustine, FL 32084-6024 Ph: (904) 436-8001 | Superior Podiatry, Llc 1690 Us Highway 1 S Ste C, Saint Augustine, FL 32084-6024 Ph: (904) 436-8001 |
Dawn Miles Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 220 Southpark Cir E, Saint Augustine, FL 32086 Phone: 904-808-9950 | |
Dr. Daniel Alexander Black, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 113 Nature Walk Pkwy, Unit 105, Saint Augustine, FL 32092 Phone: 315-382-5910 | |
Dr. John Demetrios Lagoutaris, D.P.M. Podiatrist Medicare: Medicare Enrolled Practice Location: 300 Kingsley Lake Dr, Ste. 402, Saint Augustine, FL 32092 Phone: 904-826-1375 Fax: 904-779-4964 | |
St. Johns Podiatry & Wound Care Specialists Llc Podiatrist Medicare: Medicare Enrolled Practice Location: 113 Nature Walk Pwky, Ste. 105, Saint Augustine, FL 32092 Phone: 315-382-5910 |