Provider Demographics
NPI:1376738971
Name:HM PODIATRY PA
Entity Type:Organization
Organization Name:HM PODIATRY PA
Other - Org Name:ACADEMY FOOT & ANKLE SPECIALISTS AT KELLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-424-3668
Mailing Address - Street 1:1940 E STATE HWY 114
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-424-3668
Mailing Address - Fax:817-442-8637
Practice Address - Street 1:1940 E STATE HWY 114
Practice Address - Street 2:SUITE 150
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-424-3668
Practice Address - Fax:817-442-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427057348OtherDR. AMELUNG NPI
TX1558321810OtherDR MARCIANO NPI
TX00408ZOtherMEDICARE GROUP
TX0013MSOtherBCBS GROUP
TX1558321810OtherDR MARCIANO NPI