1992048938 NPI number — ADVANCED FOOT CARE, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992048938 NPI number — ADVANCED FOOT CARE, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED FOOT CARE, LLP
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:
1992048938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2368 BATTLEFIELD PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT. OGLETHORPE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-861-6200
Provider Business Mailing Address Fax Number:
706-861-6222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3742 TENNESSEE AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37409-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-861-6200
Provider Business Practice Location Address Fax Number:
706-861-6222
Provider Enumeration Date:
03/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KRAUS
Authorized Official First Name:
IRA
Authorized Official Middle Name:
HENRI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-861-6200

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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