Healthcare Provider Details

I. General information

NPI: 1134357619
Provider Name (Legal Business Name): FOOT PAIN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 S SHERWOOD FOREST BLVD STE. 360
BATON ROUGE LA
70816-4361
US

IV. Provider business mailing address

3851 S SHERWOOD FOREST BLVD STE. 360
BATON ROUGE LA
70816-4361
US

V. Phone/Fax

Practice location:
  • Phone: 225-293-0068
  • Fax: 225-293-0018
Mailing address:
  • Phone: 225-293-0068
  • Fax: 225-293-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberPD225R
License Number StateLA

VIII. Authorized Official

Name: DR. HIEU TU VUONG
Title or Position: MEMBER
Credential: D.P.M.
Phone: 225-293-0068