Provider Demographics
NPI:1093924433
Name:NORTH TEXAS FOOT AND ANKLE, PA
Entity Type:Organization
Organization Name:NORTH TEXAS FOOT AND ANKLE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAUSENFLUKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-530-3000
Mailing Address - Street 1:2020 N GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4125
Mailing Address - Country:US
Mailing Address - Phone:972-530-3000
Mailing Address - Fax:214-369-6259
Practice Address - Street 1:2020 N GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4125
Practice Address - Country:US
Practice Address - Phone:972-530-3000
Practice Address - Fax:214-369-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1516213ES0103X, 332B00000X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168695801Medicaid
TX5025080001Medicare NSC
TXU81593Medicare UPIN
TX00023PMedicare PIN
TX5025080002Medicare NSC
TXU81593Medicare UPIN