Provider Demographics
NPI:1093894651
Name:ALLEN'S PODIATRY CLINIC
Entity Type:Organization
Organization Name:ALLEN'S PODIATRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:985-340-0099
Mailing Address - Street 1:16026 DOCTORS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1478
Mailing Address - Country:US
Mailing Address - Phone:985-340-0099
Mailing Address - Fax:985-340-1130
Practice Address - Street 1:16026 DOCTORS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1478
Practice Address - Country:US
Practice Address - Phone:985-340-0099
Practice Address - Fax:985-340-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD315R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1156744Medicaid
4834520001Medicare NSC
LA5CF60Medicare ID - Type UnspecifiedMEDICARE CLINIC PROVIDER