Provider Demographics
NPI:1053469304
Name:LOREEN KETELS FLAHERTY
Entity Type:Organization
Organization Name:LOREEN KETELS FLAHERTY
Other - Org Name:FLAHERTY FOOTCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-636-1586
Mailing Address - Street 1:2914 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5731
Mailing Address - Country:US
Mailing Address - Phone:559-627-2849
Mailing Address - Fax:559-627-9772
Practice Address - Street 1:2914 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5731
Practice Address - Country:US
Practice Address - Phone:559-627-2849
Practice Address - Fax:559-627-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4191960001Medicare NSC