Provider Demographics
NPI:1376750331
Name:LAREDO'S FOOT CARE CENTER, PA
Entity Type:Organization
Organization Name:LAREDO'S FOOT CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-726-9797
Mailing Address - Street 1:PO BOX 60998
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0998
Mailing Address - Country:US
Mailing Address - Phone:361-452-4978
Mailing Address - Fax:361-452-5026
Practice Address - Street 1:6828 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2286
Practice Address - Country:US
Practice Address - Phone:956-726-9797
Practice Address - Fax:956-726-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty