Provider Demographics
NPI:1417288937
Name:FOOT CARE CENTER OF HARRISONBURG, INC
Entity Type:Organization
Organization Name:FOOT CARE CENTER OF HARRISONBURG, INC
Other - Org Name:GREGORY A. SHILLING DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:540-434-3668
Mailing Address - Street 1:1880 RESERVOIR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8742
Mailing Address - Country:US
Mailing Address - Phone:540-434-3668
Mailing Address - Fax:540-574-0256
Practice Address - Street 1:1880 RESERVOIR ST
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8742
Practice Address - Country:US
Practice Address - Phone:540-434-3668
Practice Address - Fax:540-574-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000733213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417288937Medicaid
VA1417288937Medicaid
VA1417288937Medicare PIN