Provider Demographics
NPI:1023317559
Name:THE FOOT CARE CLINIC,LLC
Entity type:Organization
Organization Name:THE FOOT CARE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SHULER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-509-0011
Mailing Address - Street 1:1850 REDMOND CIR NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1455
Mailing Address - Country:US
Mailing Address - Phone:706-509-0011
Mailing Address - Fax:
Practice Address - Street 1:1850 REDMOND CIR NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1455
Practice Address - Country:US
Practice Address - Phone:706-509-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN111878NP261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G708485Medicare PIN