Provider Demographics
NPI:1285830547
Name:DR. MARCO A. VARGAS P.A
Entity Type:Organization
Organization Name:DR. MARCO A. VARGAS P.A
Other - Org Name:FAMILY FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-313-0030
Mailing Address - Street 1:17510 W GRAND PARKWAY SOUTH
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3244
Mailing Address - Country:US
Mailing Address - Phone:281-313-0090
Mailing Address - Fax:281-232-7918
Practice Address - Street 1:17510 W GRAND PARKWAY SOUTH
Practice Address - Street 2:SUITE 530
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3244
Practice Address - Country:US
Practice Address - Phone:281-313-0090
Practice Address - Fax:281-232-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU75643Medicare UPIN
TX00919EMedicare ID - Type Unspecified