MEDICARE: FOOT CARE CENTER OF HARRISONBURG, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0103000733	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417288937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT CARE CENTER OF HARRISONBURG, INC

Provider Business Mailing Address
First Line	:	1880 RESERVOIR ST
Second Line	:	SUITE A
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8742
Country	:	US
Telephone Number	:	540-434-3668
Fax Number	:	540-574-0256

Provider Business Practice Location Address
First Line	:	1880 RESERVOIR ST
Second Line	:	SUITE A
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8742
Country	:	US
Telephone Number	:	540-434-3668
Fax Number	:	540-574-0256

Authorized Official
Title or Position	:	OWNER/PODIATRIST
Name	:	GREGORY A SHILLING
Credential	:	DPM
Telephone Number	:	540-434-3668

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2015

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