Provider Demographics
NPI:1033367669
Name:COMPASSIONATE FOOT CARE CLINIC, PA
Entity Type:Organization
Organization Name:COMPASSIONATE FOOT CARE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-948-3576
Mailing Address - Street 1:2776 BAY SHORE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-7255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2776 BAY SHORE LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-7255
Practice Address - Country:US
Practice Address - Phone:817-948-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1848213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083SGOtherBLUE CROSS BLUE SHIELD OF TX
TX8536466OtherCIGNA
TX193700504Medicaid
TX193700504Medicaid
TX0083SGOtherBLUE CROSS BLUE SHIELD OF TX
TX6224420001Medicare NSC