Provider Demographics
NPI:1013582030
Name:WATER OAK FOOT AND ANKLE SURGERY
Entity Type:Organization
Organization Name:WATER OAK FOOT AND ANKLE SURGERY
Other - Org Name:WATER OAK FOOT AND ANKLE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:325-480-2063
Mailing Address - Street 1:2270 MATLOCK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3710
Mailing Address - Country:US
Mailing Address - Phone:325-480-2063
Mailing Address - Fax:702-514-6292
Practice Address - Street 1:2270 MATLOCK RD STE 104
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3710
Practice Address - Country:US
Practice Address - Phone:325-480-2063
Practice Address - Fax:702-514-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8LA099OtherBCBS REGISTERED ID
TX8LA098OtherBCBS REGISTERED ID