MEDICARE: ADVANTAGE FOOT CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	PD177R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4E162	OTHER	LA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083899934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE FOOT CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1054
Second Line	:
City	:	LULING
State	:	LA
Zip	:	70070-1054
Country	:	US
Telephone Number	:	985-331-1865
Fax Number	:	985-785-1445

Provider Business Practice Location Address
First Line	:	2809 SAINT CLAUDE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7224
Country	:	US
Telephone Number	:	504-947-3668
Fax Number	:	504-947-4444

Authorized Official
Title or Position	:	OWNER
Name	:	DR. YACARA TABB
Credential	:	D.P.M.
Telephone Number	:	504-905-9458

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	03/15/2011

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Directions to “ADVANTAGE FOOT CARE, LLC ” Practice Location

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