Provider Demographics
NPI:1326217191
Name:ALTERNATIVE FOOT CLINIC APMC
Entity type:Organization
Organization Name:ALTERNATIVE FOOT CLINIC APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-928-7065
Mailing Address - Street 1:4560 NORTH BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4043
Mailing Address - Country:US
Mailing Address - Phone:225-928-7065
Mailing Address - Fax:225-928-7021
Practice Address - Street 1:4560 NORTH BLVD STE 119
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4043
Practice Address - Country:US
Practice Address - Phone:225-928-7065
Practice Address - Fax:225-928-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD068R332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4358090820OtherBLUE CROSS BLUE SHIELD
LA1359891Medicaid
LA1359891Medicaid
LA1359891Medicaid
LA56038Medicare PIN
LA4358090820OtherBLUE CROSS BLUE SHIELD