Provider Demographics
NPI:1053503482
Name:FOOT SPECIALISTS OF TRI-COUNTY PA
Entity Type:Organization
Organization Name:FOOT SPECIALISTS OF TRI-COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-885-2754
Mailing Address - Street 1:119 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2138
Mailing Address - Country:US
Mailing Address - Phone:903-885-2754
Mailing Address - Fax:903-347-1207
Practice Address - Street 1:119 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2138
Practice Address - Country:US
Practice Address - Phone:903-885-3754
Practice Address - Fax:903-347-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1633P261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176461502Medicaid
TX176461501Medicaid