Provider Demographics
NPI:1073147245
Name:GEORGE C. BAKATSAS, D.P.M., L.L.C.
Entity Type:Organization
Organization Name:GEORGE C. BAKATSAS, D.P.M., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKATSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:806-300-0134
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-0098
Mailing Address - Country:US
Mailing Address - Phone:806-300-0134
Mailing Address - Fax:806-300-0851
Practice Address - Street 1:6849 82ND ST STE 102
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5136
Practice Address - Country:US
Practice Address - Phone:806-300-0134
Practice Address - Fax:806-300-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty