MEDICARE: FOOT PAIN CLINIC, 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	261QP1100X	Podiatric Clinic/Center	PD225R	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1134357619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT PAIN CLINIC, LLC

Provider Business Mailing Address
First Line	:	3851 S SHERWOOD FOREST BLVD
Second Line	:	STE. 360
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4361
Country	:	US
Telephone Number	:	225-293-0068
Fax Number	:	225-293-0018

Provider Business Practice Location Address
First Line	:	3851 S SHERWOOD FOREST BLVD
Second Line	:	STE. 360
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4361
Country	:	US
Telephone Number	:	225-293-0068
Fax Number	:	225-293-0018

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. HIEU TU VUONG
Credential	:	D.P.M.
Telephone Number	:	225-293-0068

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	02/01/2010

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Directions to “FOOT PAIN CLINIC, LLC ” Practice Location

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