Provider Demographics
NPI:1023171816
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:H
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:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4030
Mailing Address - Country:US
Mailing Address - Phone:706-861-6200
Mailing Address - Fax:706-861-6222
Practice Address - Street 1:5617 HIGHWAY 153
Practice Address - Street 2:SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4676
Practice Address - Country:US
Practice Address - Phone:423-875-9211
Practice Address - Fax:423-877-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4499970006Medicare NSC
CI7804Medicare PIN
TN3719446Medicare PIN