Provider Demographics
NPI:1134123698
Name:ABILENE FAMILY FOOT CENTER, P.A.
Entity Type:Organization
Organization Name:ABILENE FAMILY FOOT CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:325-695-8990
Mailing Address - Street 1:2501 S WILLIS ST
Mailing Address - Street 2:STE A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6249
Mailing Address - Country:US
Mailing Address - Phone:325-695-8990
Mailing Address - Fax:325-695-0901
Practice Address - Street 1:2501 S WILLIS ST
Practice Address - Street 2:STE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6249
Practice Address - Country:US
Practice Address - Phone:325-695-8990
Practice Address - Fax:325-695-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-11
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX0675213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154726701Medicaid
TX00917TOtherPTAN
TX4791770001Medicare NSC
TXT11901Medicare UPIN