Provider Demographics
NPI:1316018252
Name:RX FOOTCENTERS, INC.
Entity Type:Organization
Organization Name:RX FOOTCENTERS, INC.
Other - Org Name:LAVIRI COMFORT SHOES & PEDORTHICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:770-461-3360
Mailing Address - Street 1:570 N JEFF DAVIS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1834
Mailing Address - Country:US
Mailing Address - Phone:770-461-3360
Mailing Address - Fax:770-461-4079
Practice Address - Street 1:570 N JEFF DAVIS DR
Practice Address - Street 2:SUITE D
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1834
Practice Address - Country:US
Practice Address - Phone:770-461-3360
Practice Address - Fax:770-461-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52682648001OtherBCBSGA
GAL1697OtherKAISER PERMANENTE
GAL1697OtherKAISER PERMANENTE
GA52682648001OtherBCBSGA