Provider Demographics
NPI:1114139730
Name:ADVANCED FOOT & ANKLE CENTER OF TEXARKANA, P.A.
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE CENTER OF TEXARKANA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-791-1222
Mailing Address - Street 1:2801 RICHMOND RD # 62
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2123
Mailing Address - Country:US
Mailing Address - Phone:903-791-1222
Mailing Address - Fax:903-791-8310
Practice Address - Street 1:5606 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1819
Practice Address - Country:US
Practice Address - Phone:903-791-1222
Practice Address - Fax:903-791-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018709801Medicaid
TXDR8730OtherRAILROAD MEDICARE
AR128263717Medicaid
TX6488120001Medicare NSC
TXDR8730OtherRAILROAD MEDICARE
TXTXB130289Medicare PIN