Provider Demographics
NPI:1003954249
Name:SOUTH TEXAS FOOT SPECIALIST, PA
Entity Type:Organization
Organization Name:SOUTH TEXAS FOOT SPECIALIST, PA
Other - Org Name:SOUTH TEXAS FOOT SPECIALIST, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-439-3182
Mailing Address - Street 1:PO BOX 57099
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7099
Mailing Address - Country:US
Mailing Address - Phone:281-996-9546
Mailing Address - Fax:281-996-7645
Practice Address - Street 1:119 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3818
Practice Address - Country:US
Practice Address - Phone:281-996-9546
Practice Address - Fax:281-996-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213ES0103X213ES0103X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032LCOtherBCBS GROUP PROVIDER NUMBE
TXDC2673OtherRAILROAD MEDICARE
TX178180901Medicaid
TX119842602Medicaid
TX119842602Medicaid
TX0032LCOtherBCBS GROUP PROVIDER NUMBE
TXT83367Medicare UPIN
TX5006050002Medicare NSC
TXDC2673OtherRAILROAD MEDICARE
TX178180901Medicaid
TX8C2417Medicare PIN