Provider Demographics
NPI:1124571096
Name:THE FOOT AND ANKLE CLINIC OF WEST MONROE, LLC
Entity Type:Organization
Organization Name:THE FOOT AND ANKLE CLINIC OF WEST MONROE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-397-1574
Mailing Address - Street 1:2269 ARKANSAS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7818
Mailing Address - Country:US
Mailing Address - Phone:318-397-1574
Mailing Address - Fax:318-397-1672
Practice Address - Street 1:5745 HWY 17
Practice Address - Street 2:
Practice Address - City:CROWVILLE
Practice Address - State:LA
Practice Address - Zip Code:71230
Practice Address - Country:US
Practice Address - Phone:318-397-1574
Practice Address - Fax:318-397-1672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FOOT AND ANKLE CLINIC OF WEST MONROE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200054213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2372726Medicaid
LA1457772774OtherINDIVIDUAL NPI
LA7175150001Medicare PIN
LA1457772774OtherINDIVIDUAL NPI