Healthcare Provider Details

I. General information

NPI: 1861487290
Provider Name (Legal Business Name): THE FOOT CLINIC OF WEST LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 PORT ARTHUR TER
LEESVILLE LA
71446-4600
US

IV. Provider business mailing address

1108 PORT ARTHUR TER
LEESVILLE LA
71446-4600
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-1061
  • Fax: 337-239-1062
Mailing address:
  • Phone: 337-239-1061
  • Fax: 337-239-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JIMMIE B HARVEY
Title or Position: OWNER
Credential: DPM
Phone: 337-239-1061