Provider Demographics
NPI:1588773337
Name:BROWN FOOT CARE CENTER, PC
Entity type:Organization
Organization Name:BROWN FOOT CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-372-0708
Mailing Address - Street 1:204 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:EUTAW
Mailing Address - State:AL
Mailing Address - Zip Code:35462-1123
Mailing Address - Country:US
Mailing Address - Phone:205-372-0708
Mailing Address - Fax:205-372-0720
Practice Address - Street 1:204 PICKENS ST
Practice Address - Street 2:
Practice Address - City:EUTAW
Practice Address - State:AL
Practice Address - Zip Code:35462-1123
Practice Address - Country:US
Practice Address - Phone:205-372-0708
Practice Address - Fax:205-372-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00187213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU69736Medicare UPIN
AL51516666Medicare ID - Type UnspecifiedDEMOPOLIS
AL51506312Medicare ID - Type UnspecifiedTUSCALOOSA
AL4133320001Medicare NSC