Provider Demographics
NPI:1740404714
Name:BEST PODIATRY CENTER
Entity Type:Organization
Organization Name:BEST PODIATRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:574-266-4555
Mailing Address - Street 1:1755 FULTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1927
Mailing Address - Country:US
Mailing Address - Phone:574-266-4555
Mailing Address - Fax:574-266-1315
Practice Address - Street 1:1755 FULTON ST STE B
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1927
Practice Address - Country:US
Practice Address - Phone:574-266-4555
Practice Address - Fax:574-266-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000564A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34637Medicare UPIN
IN215860Medicare ID - Type Unspecified
IN5494530001Medicare NSC