Provider Demographics
NPI:1588240485
Name:LOUISIANA FOOT AND ANKLE SURGEONS, LLC
Entity Type:Organization
Organization Name:LOUISIANA FOOT AND ANKLE SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DYLAN
Authorized Official - Last Name:LAMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-826-7501
Mailing Address - Street 1:401 VETERANS BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2957
Mailing Address - Country:US
Mailing Address - Phone:504-835-1849
Mailing Address - Fax:
Practice Address - Street 1:179 BELLE TERRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3357
Practice Address - Country:US
Practice Address - Phone:985-651-6096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2545523Medicaid