Provider Demographics
NPI:1003844176
Name:FOOT AND ANKLE ASSOCIATES OF NORTH TEXAS, LLP
Entity Type:Organization
Organization Name:FOOT AND ANKLE ASSOCIATES OF NORTH TEXAS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CERAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-796-3245
Mailing Address - Street 1:2421 IRA E WOODS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3906
Mailing Address - Country:US
Mailing Address - Phone:817-416-6155
Mailing Address - Fax:817-329-9434
Practice Address - Street 1:2421 IRA E WOODS AVE
Practice Address - Street 2:STE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3906
Practice Address - Country:US
Practice Address - Phone:817-416-6155
Practice Address - Fax:817-329-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00576UOtherBCBS
TXDA2700Medicare PIN
4943100001Medicare NSC
TX00567UMedicare PIN
4943100003Medicare NSC
TX00576UMedicare PIN