Provider Demographics
NPI:1114004611
Name:PRECISION FOOT CARE CENTER, LLC
Entity Type:Organization
Organization Name:PRECISION FOOT CARE CENTER, LLC
Other - Org Name:PRECISION FOOT CARE CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MBA
Authorized Official - Phone:540-328-0777
Mailing Address - Street 1:PO BOX 50343
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70150-0343
Mailing Address - Country:US
Mailing Address - Phone:504-328-0777
Mailing Address - Fax:504-328-0314
Practice Address - Street 1:4700 WICHERS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3041
Practice Address - Country:US
Practice Address - Phone:504-328-0777
Practice Address - Fax:504-328-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD256R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DF70Medicare PIN
LA4919320001Medicare NSC