Provider Demographics
NPI:1083922710
Name:NORTH CENTRAL TEXAS PODIATRY, PA
Entity Type:Organization
Organization Name:NORTH CENTRAL TEXAS PODIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:940-627-6976
Mailing Address - Street 1:1713 S FM 51
Mailing Address - Street 2:103
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3642
Mailing Address - Country:US
Mailing Address - Phone:940-627-6976
Mailing Address - Fax:940-627-3491
Practice Address - Street 1:1713 S FM 51
Practice Address - Street 2:103
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3642
Practice Address - Country:US
Practice Address - Phone:940-627-6976
Practice Address - Fax:940-627-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1305213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071TYOtherBCBS
TX285988601Medicaid
TXTXB127139Medicare PIN