PHYSICIANS GROUP SERVICES PA (NPI# 1962860619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962860619 |
| Entity Type | Organization |
| Organization Name | PHYSICIANS GROUP SERVICES PA |
| Other Organization Name | COASTAL PODIATRY AND WOUND CARE |
| Practice Address |
3839 County Road 218 Middleburg FL 32068-5708 |
| Mailing Address |
421 Kingsley Ave Suite 401 Orange Park FL 32073-4897 |
| Practice Telephone | 9042826331 |
| Practice Fax Number | 9042140059 |
| Mailing Telephone | 9042650470 |
| Mailing Fax Number | 9042233949 |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |
| Authorized Official Name | DR. KENT T BRAEUTIGAM (PRESIDENT) |
| Authorized Official Telephone | 9042826331 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 259123500 | 05 |
| Other Name | Type Code |
|---|---|
| COASTAL PODIATRY AND WOUND CARE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841674314 | Physicians Group Services Pa | Pediatrics | 421 Kingsley Ave Ste 300, Orange Park, FL 32073-4898 | 2015-07-15 |
| 1861440810 | Physicians Group Services Pa | Nurse Practitioner | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-05-04 |
| 1932682986 | Physicians Group Services Pa | Clinic/Center | 421 Kingsley Ave Ste 400, Orange Park, FL 32073-4898 | 2018-09-14 |
| 1497118160 | Physicians Group Services Pa | Family Medicine | 14810 Old Saint Augustine Rd, Suite 207, Jacksonville, FL 32258-2451 | 2016-03-31 |
| 1699138362 | Physicians Group Services Pa | Family Medicine | 1689 Eagle Harbor Pkwy, Suite A, Fleming Island, FL 32003-4817 | 2016-03-31 |
| 1952706368 | Physicians Group Services Pa | Family Medicine | 2700 Riverside Ave, Suite 2, Jacksonville, FL 32205-8275 | 2014-10-28 |
| 1699170035 | Physicians Group Services Pa | Family Medicine | 13241 Bartram Park Blvd, Suite 1101, Jacksonville, FL 32258-5212 | 2014-10-28 |
| 1831530658 | Physicians Group Services Pa | Family Medicine | 421 Kingsley Ave, Orange Park, FL 32073-4897 | 2013-07-09 |
| 1598105686 | Physicians Group Services Pa | Family Medicine | 6816 Southpoint Pkwy, Suite 102, Jacksonville, FL 32216-1700 | 2013-07-03 |
| 1821339920 | Physicians Group Services Pa | Orthopaedic Surgery | 2255 Dunn Ave, Building 100, Jacksonville, FL 32218-4719 | 2013-03-14 |
| Street Address |
3839 COUNTY ROAD 218 |
| City | MIDDLEBURG |
| State | FL |
| Zip Code | 32068-5708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861440810 | Physicians Group Services Pa | Nurse Practitioner | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-05-04 |
| 1316432503 | Heather Pauline Bennett | Nurse Practitioner | 3839 County Road 218, Middleburg, FL 32068 | 2018-06-29 |
| 1245587393 | Casey Todd | Nurse Practitioner | 3839 County Road 218, Middleburg, FL 32068-5708 | 2012-08-08 |
| 1912927237 | Mary Josephine Sutherland | Physician Assistant | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-07-20 |
| 1043238132 | Maria Elana Mora | Pediatrics | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-07-17 |
| 1821013459 | Benjamin Wo-shun Goh | Family Medicine | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-07-13 |
| 1063437861 | Kent Thomas Braeutigam | Family Medicine | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-07-13 |
| 1972536100 | Betty Michelle Pate | Nurse Practitioner | 3839 County Road 218, Middleburg, FL 32068-5708 | 2006-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073084174 | Christopher Littles | Technician | 3122 Angora Bay Dr, Middleburg, FL 32068 | 2018-12-16 |
| 1730685157 | Children's Express Care Clinic | Pediatrics | 430 College Drive, Suite 100-102, Middleburg, FL 32068 | 2018-04-04 |
| 1588162762 | Lp Sw Jacksonville, LLC | Skilled Nursing Facility | 1280 Henley Road, Middleburg, FL 32068 | 2018-01-23 |
| 1396264982 | Michael Jessie Visita Roberts | Physical Therapy Assistant | 1648 St. Vincents Way, 100b, Middleburg, FL 32068 | 2017-09-14 |
| 1093239915 | Kevia Hart | In Home Supportive Care | 2718 Tina Lane, Middleburg, FL 32068 | 2017-08-02 |
| 1366899825 | Serena Burr | Midwife | 1986 Friendly Pl, Middleburg, FL 32068 | 2016-05-15 |
| 1932573672 | Jamie Dietrich | Physical Therapist | 2583-3 County Road 220, Middleburg, FL 32068 | 2015-11-18 |
| 1154791614 | Katherine Wenger | Physical Therapist | 2580-3 Country Road 220, Suite 3, Middleburg, FL 32068 | 2015-09-28 |
| 1699024240 | Amanda Copeland | Speech-Language Pathologist | 2823 Woodstone Dr., Middleburg, FL 32068 | 2012-08-29 |
| 1194089243 | Good Samaritan Home Companion Services, Inc. | In Home Supportive Care | 3689 Main Street, Middleburg, FL 32068 | 2012-07-03 |
| Find all providers in zip 32068 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693120 | Mozhgan Alijani, Dpm, Pa | Podiatrist | 20515 E Country Club Dr Apt 544, Miami, FL 33180-3442 | 2020-09-11 |
| 1730790551 | Sacred Heart Hospital of Pensacola | Podiatrist | 1890 Summit Blvd, Pensacola, FL 32503 | 2020-08-14 |
| 1306457841 | Asdj LLC | Podiatrist | 2190 Bridgeport Cir, Rockledge, FL 32955-4338 | 2020-08-10 |
| 1316557762 | Upperline Healthcare, PC | Podiatrist | 2111 Glenwood Dr Ste 104, Winter Park, FL 32792-3328 | 2020-07-31 |
| 1790395135 | Upperline Healthcare, PC | Podiatrist | 339 Cypress Pkwy Ste 240, Kissimmee, FL 34759-3315 | 2020-07-31 |
| 1952911398 | Upperline Healthcare, PC | Podiatrist | 250 N Alafaya Trl Ste 115, Orlando, FL 32828-4336 | 2020-07-31 |
| 1639789076 | Upperline Healthcare, PC | Podiatrist | 650 S Courtenay Pkwy Ste 200, Merritt Island, FL 32952-4977 | 2020-07-31 |
| 1972113314 | Upperline Healthcare, PC | Podiatrist | 8000 Red Bug Lake Rd Ste 230, Oviedo, FL 32765-9265 | 2020-07-31 |
| 1356950646 | Palm Beach Foot & Ankle Inc | Podiatrist | 8130 Royal Palm Blvd Ste 205, Coral Springs, FL 33065-5703 | 2020-07-23 |
| 1720601891 | Yohandy Fuentes Dpm Pa | Podiatrist | 5200 Sw 8th St Ste 201a, Coral Gables, FL 33134-2337 | 2020-05-24 |
| Find all providers with the same taxonomy | ||||
| City | MIDDLEBURG |
| Zip Code | 32068 |
Please comment or provide details below to improve the information on PHYSICIANS GROUP SERVICES PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.