1164852125 NPI number — ADVANTAGE FOOT CARE

Table of content: LASHONDA NICOLE HARRIS LPN (NPI 1043558174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164852125 NPI number — ADVANTAGE FOOT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE FOOT CARE
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:
6
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:
1164852125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 PLEASANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-228-3008
Provider Business Mailing Address Fax Number:
603-448-7148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-3008
Provider Business Practice Location Address Fax Number:
603-448-7148
Provider Enumeration Date:
11/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
NEWCOTT
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PODIATRIST OWNER
Authorized Official Telephone Number:
603-228-3008

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  147 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NH8273 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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