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General NPI Number Information
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NPI Number | 1588115372
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Entity Type | Organization
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Legal Business Name | ELITE FEET LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 680 ASHBURNHAM HILL RD
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City | FITCHBURG
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State | MA
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Zip | 01420-1866
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Country | US
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Telephone | 978-423-8907
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Fax | 978-343-3188
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Provider Business Mailing Address
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Address Line | PO BOX 2111
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City | FITCHBURG
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State | MA
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Zip | 01420-0013
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Country | US
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Telephone | 978-423-8907
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM COIT HUBBARD
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Credential | DPM
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Telephone | 978-423-8907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | POD2007
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License Number State | MA
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