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General NPI Number Information
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NPI Number | 1396950580
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Entity Type | Organization
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Legal Business Name | FOOT SPECIALISTS OF SHREVEPORT
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 7821 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-5505
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Country | US
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Telephone | 318-213-3668
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Fax | 318-213-3670
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Provider Business Mailing Address
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Address Line | 7821 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-5505
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Country | US
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Telephone | 318-213-3668
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Fax | 318-213-3670
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLI A FULFORD
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Credential |
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Telephone | 318-213-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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