Provider Demographics
NPI:1003147356
Name:CAPITAL FOOT & ANKLE SURGEONS OF AUSTIN, PLLC
Entity Type:Organization
Organization Name:CAPITAL FOOT & ANKLE SURGEONS OF AUSTIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-474-6666
Mailing Address - Street 1:900 E 30TH ST
Mailing Address - Street 2:311
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-474-6666
Mailing Address - Fax:512-474-6668
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:311
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-474-6666
Practice Address - Fax:512-474-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6003Medicare PIN
TX6383820001Medicare NSC