Provider Demographics
NPI:1003930231
Name:COMPLETE FOOT AND ANKLE CARE OF NORTH TEXAS, PA
Entity Type:Organization
Organization Name:COMPLETE FOOT AND ANKLE CARE OF NORTH TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:STONE BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-300-3054
Mailing Address - Street 1:3319 UNICORN LAKE BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0121
Mailing Address - Country:US
Mailing Address - Phone:940-300-3054
Mailing Address - Fax:940-243-7780
Practice Address - Street 1:3319 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0121
Practice Address - Country:US
Practice Address - Phone:940-300-3054
Practice Address - Fax:940-243-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4167587-01Medicaid
0020PSOtherBCBS