Provider Demographics
NPI:1538307863
Name:FOOT CARE AND SURGICAL CENTER
Entity Type:Organization
Organization Name:FOOT CARE AND SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-320-0584
Mailing Address - Street 1:47026 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-7323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 5TH AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4159
Practice Address - Country:US
Practice Address - Phone:601-362-3158
Practice Address - Fax:601-987-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015989Medicaid
LA1323462Medicaid
MS00015989Medicaid