Provider Demographics
NPI:1376720565
Name:ELITE FOOTCARE OF TEXAS INC.
Entity Type:Organization
Organization Name:ELITE FOOTCARE OF TEXAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR 1
Authorized Official - Prefix:DR
Authorized Official - First Name:KURTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MSIS
Authorized Official - Phone:281-489-6594
Mailing Address - Street 1:10223 BROADWAY ST
Mailing Address - Street 2:STE. P246
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:281-489-6594
Mailing Address - Fax:
Practice Address - Street 1:4501 CARTWRIGHT RD
Practice Address - Street 2:STE 208
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3534
Practice Address - Country:US
Practice Address - Phone:832-539-1620
Practice Address - Fax:832-539-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1563213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1529075002Medicaid
TXU87354Medicare UPIN
TX5143640001Medicare NSC