Provider Demographics
NPI:1578093803
Name:505 FOOT CARE LLC
Entity Type:Organization
Organization Name:505 FOOT CARE LLC
Other - Org Name:BENJAMIN HOCKIN DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-210-2113
Mailing Address - Street 1:8019 LAVA REACH AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6531
Mailing Address - Country:US
Mailing Address - Phone:505-210-2113
Mailing Address - Fax:505-962-0701
Practice Address - Street 1:8019 LAVA REACH AVE NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6531
Practice Address - Country:US
Practice Address - Phone:505-210-2113
Practice Address - Fax:505-962-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM393213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty