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General NPI Number Information
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NPI Number | 1083899934
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Entity Type | Organization
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Legal Business Name | ADVANTAGE FOOT CARE, LLC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 2809 SAINT CLAUDE AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70117-7224
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Country | US
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Telephone | 504-947-3668
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Fax | 504-947-4444
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Provider Business Mailing Address
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Address Line | PO BOX 1054
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City | LULING
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State | LA
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Zip | 70070-1054
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Country | US
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Telephone | 985-331-1865
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Fax | 985-785-1445
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Authorized Official
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Title or Position | OWNER
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Name | DR. YACARA TABB
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Credential | D.P.M.
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Telephone | 504-905-9458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PD177R
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License Number State | LA
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