Provider Demographics
NPI:1326589797
Name:PODIACARE, LLC
Entity Type:Organization
Organization Name:PODIACARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-258-3011
Mailing Address - Street 1:PO BOX 6853
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-6853
Mailing Address - Country:US
Mailing Address - Phone:832-258-3011
Mailing Address - Fax:281-713-1136
Practice Address - Street 1:3415 HAVENBROOK DR
Practice Address - Street 2:1706
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2617
Practice Address - Country:US
Practice Address - Phone:832-258-3011
Practice Address - Fax:281-713-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1913213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548369168OtherNPI
TX215221701Medicaid
TX1548369168Medicare NSC