Provider Demographics
NPI:1306022595
Name:COMFORT PODIATRY, PA
Entity Type:Organization
Organization Name:COMFORT PODIATRY, PA
Other - Org Name:COMFORT PODIATRY, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-398-1234
Mailing Address - Street 1:1151 N BUCKNER BLVD STE 304
Mailing Address - Street 2:PROFESSIONAL BLDG. 1
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3405
Mailing Address - Country:US
Mailing Address - Phone:214-398-1234
Mailing Address - Fax:214-398-1386
Practice Address - Street 1:1151 N BUCKNER BLVD STE 304
Practice Address - Street 2:PROFESSIONAL
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3405
Practice Address - Country:US
Practice Address - Phone:214-398-1234
Practice Address - Fax:214-398-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDO6641OtherRAIL ROAD MEDICARE GROUP PTAN
TX0034NCOtherBCBS
TX176120701Medicaid
TXU85404Medicare UPIN
TX176120701Medicaid
TX0034NCOtherBCBS