1306045588 NPI number — LAKEVIEW FAMILY FOOT CARE L.L.C.

Table of content: (NPI 1306045588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306045588 NPI number — LAKEVIEW FAMILY FOOT CARE L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW FAMILY FOOT CARE L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306045588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUNTERSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35976-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-582-7486
Provider Business Mailing Address Fax Number:
256-582-9844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1604 BLOUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUNTERSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35976-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-582-7486
Provider Business Practice Location Address Fax Number:
256-582-9844
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SKAZIAK
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
ALFRED
Authorized Official Title or Position:
PODIATRIST/OWNER
Authorized Official Telephone Number:
256-582-7486

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  171 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51078853SKA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000078853 . This is a "MEDICARE LEGACY PROVIDER#" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: DP9341 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2710035 . This is a "UNITED HEALTH CARE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38652 . This is a "HEALTH PARTNERS #" identifier . This identifiers is of the category "OTHER".




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