Provider Demographics
NPI:1992048938
Name:ADVANCED FOOT CARE, LLP
Entity type:Organization
Organization Name:ADVANCED FOOT CARE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:HENRI
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-861-6200
Mailing Address - Street 1:2368 BATTLEFIELD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FT. OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742
Mailing Address - Country:US
Mailing Address - Phone:706-861-6200
Mailing Address - Fax:706-861-6222
Practice Address - Street 1:3742 TENNESSEE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1215
Practice Address - Country:US
Practice Address - Phone:706-861-6200
Practice Address - Fax:706-861-6222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED FOOT CARE, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-28
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty