Provider Demographics
NPI:1003467770
Name:TOTAL FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:TOTAL FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-676-9392
Mailing Address - Street 1:6300 W PARKER RD STE 425
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8104
Mailing Address - Country:US
Mailing Address - Phone:972-942-8080
Mailing Address - Fax:972-759-9083
Practice Address - Street 1:6300 W PARKER RD STE 425
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8104
Practice Address - Country:US
Practice Address - Phone:972-942-8080
Practice Address - Fax:972-759-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4122517Medicaid