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General NPI Number Information
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NPI Number | 1750730628
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Entity Type | Organization
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Legal Business Name | PODIATRY HOME CARE LLC
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 1567 ASPIN AVE SUITE B
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City | NORFOLK
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State | VA
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Zip | 23502-1532
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Country | US
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Telephone | 757-965-4765
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Fax | 757-965-4765
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Provider Business Mailing Address
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Address Line | 7750 OGDEN AVE APT A
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City | NORFOLK
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State | VA
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Zip | 23505-2069
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Country | US
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Telephone | 100-000-0000
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Fax | 757-965-4765
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDNA HOLMES
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Credential | D.P.M.
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Telephone | 100-000-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 0103000695
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License Number State | VA
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