Provider Demographics
NPI:1164017703
Name:FOOT & ANKLE SPECIALISTS OF CORPUS CHRISTI PLLC
Entity Type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS OF CORPUS CHRISTI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-977-2035
Mailing Address - Street 1:505 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1645
Mailing Address - Country:US
Mailing Address - Phone:361-977-2035
Mailing Address - Fax:361-977-2038
Practice Address - Street 1:505 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1645
Practice Address - Country:US
Practice Address - Phone:361-977-2035
Practice Address - Fax:361-977-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty