Provider Demographics
NPI:1841468238
Name:CENTRAL ALABAMA FOOT CARE LLC
Entity type:Organization
Organization Name:CENTRAL ALABAMA FOOT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:EADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-283-4178
Mailing Address - Street 1:PO BOX 780367
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-0004
Mailing Address - Country:US
Mailing Address - Phone:334-283-4178
Mailing Address - Fax:334-283-2190
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:SUITE J
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1234
Practice Address - Country:US
Practice Address - Phone:334-283-4178
Practice Address - Fax:334-283-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL71332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
515-12528OtherBCBS
AL051552056Medicaid
ALJ027OtherMEDICARE GROUP
AL529914900OtherMEDICAID GROUP
AL051552056Medicaid
AL529914900OtherMEDICAID GROUP