Provider Demographics
NPI:1205032448
Name:LAFAYETTE PODIATRY CENTER, LLC
Entity Type:Organization
Organization Name:LAFAYETTE PODIATRY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEARSTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-889-0347
Mailing Address - Street 1:205 BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6827
Mailing Address - Country:US
Mailing Address - Phone:504-889-0347
Mailing Address - Fax:504-779-9741
Practice Address - Street 1:205 BONAIRE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6827
Practice Address - Country:US
Practice Address - Phone:504-889-0347
Practice Address - Fax:504-779-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU53Medicare PIN