Provider Demographics
NPI:1134357619
Name:FOOT PAIN CLINIC, LLC
Entity type:Organization
Organization Name:FOOT PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:TU
Authorized Official - Last Name:VUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-293-0068
Mailing Address - Street 1:3851 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:STE. 360
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4361
Mailing Address - Country:US
Mailing Address - Phone:225-293-0068
Mailing Address - Fax:225-293-0018
Practice Address - Street 1:3851 S SHERWOOD FOREST BLVD
Practice Address - Street 2:STE. 360
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4361
Practice Address - Country:US
Practice Address - Phone:225-293-0068
Practice Address - Fax:225-293-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD225R261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1542466Medicaid
DP2775Medicare PIN
5DJ34Medicare PIN
5431260001Medicare NSC