Provider Demographics
NPI:1659137115
Name:ADVANCED FOOT CARE PLLC
Entity Type:Organization
Organization Name:ADVANCED FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-430-6405
Mailing Address - Street 1:2004 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2010
Mailing Address - Country:US
Mailing Address - Phone:150-943-0640
Mailing Address - Fax:
Practice Address - Street 1:2004 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2010
Practice Address - Country:US
Practice Address - Phone:150-943-0640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care