Provider Demographics
NPI:1295162980
Name:ADVANCED FOOT CARE LLC
Entity type:Organization
Organization Name:ADVANCED FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-439-8530
Mailing Address - Street 1:831 DUBLIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1023
Mailing Address - Country:US
Mailing Address - Phone:504-439-8530
Mailing Address - Fax:504-861-3132
Practice Address - Street 1:831 DUBLIN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1023
Practice Address - Country:US
Practice Address - Phone:504-439-8530
Practice Address - Fax:504-861-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PD195R213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS80180OtherPODIATRY MEDICAL LICENSE
MS05001054Medicaid
LAPD195ROtherPODIATRY MEDICAL LICENSE
LA1549525Medicaid
SC523OtherPODIATRY MEDICAL LICENSE - VOLUTARILLY PLACED ON INNACTIVE STATUS
SCPD5232Medicaid
SC523OtherPODIATRY MEDICAL LICENSE - VOLUTARILLY PLACED ON INNACTIVE STATUS
LA1549525Medicaid
SCU618830281Medicare PIN
SCPD5232Medicaid