Provider Demographics
NPI:1194083220
Name:FOOT CLINIC OF LOUISIANA INC
Entity type:Organization
Organization Name:FOOT CLINIC OF LOUISIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:TULLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-295-1027
Mailing Address - Street 1:4860 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9644
Mailing Address - Country:US
Mailing Address - Phone:225-295-1027
Mailing Address - Fax:225-295-1491
Practice Address - Street 1:2000 AUDUBON AVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5075
Practice Address - Country:US
Practice Address - Phone:985-446-2335
Practice Address - Fax:985-446-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric