Provider Demographics
NPI:1710925052
Name:FOOT SPECIALIST OF ACADIANA
Entity Type:Organization
Organization Name:FOOT SPECIALIST OF ACADIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUNEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-365-4195
Mailing Address - Street 1:521 N LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563
Mailing Address - Country:US
Mailing Address - Phone:337-365-4195
Mailing Address - Fax:337-365-9557
Practice Address - Street 1:521 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563
Practice Address - Country:US
Practice Address - Phone:337-365-4195
Practice Address - Fax:337-365-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2726031980OtherBLUE CROSS / BLUE SHIELD OF LOUISIANA
LA1448338Medicaid
LA480031731OtherMEDICARE RRB
LA480031731OtherMEDICARE RRB
LA2726031980OtherBLUE CROSS / BLUE SHIELD OF LOUISIANA