Basic Information
| Provider Information | |||||||||
| NPI: | 1992048938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED FOOT CARE, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2368 BATTLEFIELD PARKWAY | ||||||||
| Address2: | |||||||||
| City: | FT. OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068616200 | ||||||||
| FaxNumber: | 7068616222 | ||||||||
| Practice Location | |||||||||
| Address1: | 3742 TENNESSEE AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374091215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068616200 | ||||||||
| FaxNumber: | 7068616222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | KRAUS | ||||||||
| AuthorizedOfficialFirstName: | IRA | ||||||||
| AuthorizedOfficialMiddleName: | HENRI | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7068616200 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVANCED FOOT CARE, LLP | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.