Provider Demographics
NPI:1750442521
Name:ALABAMA FOOT CARE CENTER, PC
Entity Type:Organization
Organization Name:ALABAMA FOOT CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIAVARELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-741-7600
Mailing Address - Street 1:2304 GATEWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7273
Mailing Address - Country:US
Mailing Address - Phone:334-741-7600
Mailing Address - Fax:847-241-7600
Practice Address - Street 1:2304 GATEWAY DR STE B
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7273
Practice Address - Country:US
Practice Address - Phone:334-741-7600
Practice Address - Fax:847-241-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536300OtherBCBS
AL51536299OtherBCBS
AL51536298OtherBCBS
AL51038839OtherBCBS
AL000038839Medicare PIN
AL51536300OtherBCBS