Provider Demographics
NPI:1376215962
Name:FOOT CLINIC OF SOUTH TEXAS
Entity Type:Organization
Organization Name:FOOT CLINIC OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-489-5450
Mailing Address - Street 1:2436 PABLO KISEL BLVD # 1020
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4095
Mailing Address - Country:US
Mailing Address - Phone:956-489-5450
Mailing Address - Fax:
Practice Address - Street 1:500 PAREDES LINE RD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3692
Practice Address - Country:US
Practice Address - Phone:956-489-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350637002Medicaid