Provider Demographics
NPI:1467647446
Name:ADVANCED FOOT CARE PC
Entity Type:Organization
Organization Name:ADVANCED FOOT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:IOLA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-271-3333
Mailing Address - Street 1:7956 VAUGH RODE
Mailing Address - Street 2:#193
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116
Mailing Address - Country:US
Mailing Address - Phone:334-233-3364
Mailing Address - Fax:334-271-3768
Practice Address - Street 1:348 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7108
Practice Address - Country:US
Practice Address - Phone:334-271-3333
Practice Address - Fax:334-271-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL134213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL08630OtherBCBS OF ALABAMA
AL0804080001Medicare NSC
ALT93191Medicare UPIN