Provider Demographics
NPI:1164602157
Name:TEXAS FAMILY FOOTCARE PA
Entity Type:Organization
Organization Name:TEXAS FAMILY FOOTCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ANDREONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-712-4161
Mailing Address - Street 1:5575 WARREN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4062
Mailing Address - Country:US
Mailing Address - Phone:972-712-4161
Mailing Address - Fax:972-412-4289
Practice Address - Street 1:5575 WARREN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4062
Practice Address - Country:US
Practice Address - Phone:972-712-4161
Practice Address - Fax:972-412-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1481213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0055KGOtherBLUE CROSS BLUE SHIELD
TX00993UMedicare PIN