Provider Demographics
NPI:1588115372
Name:ELITE FEET LLC
Entity type:Organization
Organization Name:ELITE FEET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COIT
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-423-8907
Mailing Address - Street 1:PO BOX 2111
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-0013
Mailing Address - Country:US
Mailing Address - Phone:978-423-8907
Mailing Address - Fax:
Practice Address - Street 1:680 ASHBURNHAM HILL RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-1866
Practice Address - Country:US
Practice Address - Phone:978-423-8907
Practice Address - Fax:978-343-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPOD2007213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty