=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417288937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT CARE CENTER OF HARRISONBURG, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2010
-----------------------------------------------------
Last Update Date | 01/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 RESERVOIR ST SUITE A
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-434-3668
-----------------------------------------------------
Fax | 540-574-0256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1880 RESERVOIR ST SUITE A
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-434-3668
-----------------------------------------------------
Fax | 540-574-0256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PODIATRIST
-----------------------------------------------------
Name | GREGORY A SHILLING
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 540-434-3668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0103000733
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------