Provider Demographics
NPI:1750500468
Name:BAYOU FOOT CARE, LLC
Entity Type:Organization
Organization Name:BAYOU FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VIGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:985-649-9795
Mailing Address - Street 1:PO BOX 54005
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4005
Mailing Address - Country:US
Mailing Address - Phone:985-649-9795
Mailing Address - Fax:985-649-9772
Practice Address - Street 1:105 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5544
Practice Address - Country:US
Practice Address - Phone:985-649-9795
Practice Address - Fax:985-649-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0131X
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADD4218Medicare PIN
LA5CQ86Medicare ID - Type UnspecifiedGROUP
LA4906200001Medicare NSC
LA5CQ87Medicare ID - Type UnspecifiedGROUP