Provider Demographics
NPI:1285819763
Name:FOOT CARE OF CENTRAL SAN ANTONIO
Entity Type:Organization
Organization Name:FOOT CARE OF CENTRAL SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-517-0967
Mailing Address - Street 1:305 E EUCLID AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4709
Mailing Address - Country:US
Mailing Address - Phone:210-224-9214
Mailing Address - Fax:210-224-9254
Practice Address - Street 1:305 E EUCLID AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4709
Practice Address - Country:US
Practice Address - Phone:210-224-9214
Practice Address - Fax:210-224-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1261770001OtherMED/DME NUMBER
TX318683502Medicaid
TX1261770001Medicare NSC