Provider Demographics
NPI:1467675124
Name:BATON ROUGE FOOT CARE , PC
Entity Type:Organization
Organization Name:BATON ROUGE FOOT CARE , PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIF
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-763-7770
Mailing Address - Street 1:8160 YMCA PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0916
Mailing Address - Country:US
Mailing Address - Phone:225-763-7770
Mailing Address - Fax:225-763-7773
Practice Address - Street 1:8160 YMCA PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0916
Practice Address - Country:US
Practice Address - Phone:225-763-7770
Practice Address - Fax:225-763-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD317R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369691Medicaid
LA5104430001Medicare NSC
LA1369691Medicaid