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General NPI Number Information
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NPI Number | 1770770414
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Entity Type | Organization
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Legal Business Name | A COMPLETE FOOT CENTER LLC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 212 W MCNEESE ST
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City | LAKE CHARLES
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State | LA
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Zip | 70605
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Country | US
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Telephone | 337-474-2233
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Fax | 337-478-1994
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Provider Business Mailing Address
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Address Line | 212 W MCNEESE ST
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City | LAKE CHARLES
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State | LA
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Zip | 70605
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Country | US
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Telephone | 337-474-2233
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Fax | 337-478-1994
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Authorized Official
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Title or Position | OWNER PODIATRIST
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Name | CHARLOTTE D VANG
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Credential | DPM
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Telephone | 337-474-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PD0114
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License Number State | LA
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