Provider Demographics
NPI:1770770414
Name:A COMPLETE FOOT CENTER LLC
Entity type:Organization
Organization Name:A COMPLETE FOOT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-474-2233
Mailing Address - Street 1:212 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-474-2233
Mailing Address - Fax:337-478-1994
Practice Address - Street 1:212 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-474-2233
Practice Address - Fax:337-478-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD0114213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131814Medicaid
LA5DC18Medicare PIN