Provider Demographics
NPI:1154509313
Name:AMARILLO PODIATRY, P.A.
Entity Type:Organization
Organization Name:AMARILLO PODIATRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:806-353-1236
Mailing Address - Street 1:4014 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4434
Mailing Address - Country:US
Mailing Address - Phone:806-353-1236
Mailing Address - Fax:806-353-3310
Practice Address - Street 1:4014 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4434
Practice Address - Country:US
Practice Address - Phone:806-353-1236
Practice Address - Fax:806-353-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1493213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDN7308OtherRAILROAD MEDICARE #
TX5036710001Medicare NSC
TX00Z499Medicare PIN