Provider Demographics
NPI:1174505358
Name:PODIATRY ASSOCIATES OF VICTORIA PA
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF VICTORIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-578-2777
Mailing Address - Street 1:116 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3948
Mailing Address - Country:US
Mailing Address - Phone:361-578-2777
Mailing Address - Fax:361-578-2778
Practice Address - Street 1:116 IMPERIAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3948
Practice Address - Country:US
Practice Address - Phone:361-578-2777
Practice Address - Fax:361-578-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDB9630OtherRAILROAD MEDICARE GROUP
TX00920KOtherBCBS GROUP NUMBER
TXDB9630OtherRAILROAD MEDICARE GROUP
TX00920KMedicare PIN