Provider Demographics
NPI:1407983281
Name:ADVANCED FOOT AND ANKLE FAMILY CLINIC , PA
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE FAMILY CLINIC , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-251-7252
Mailing Address - Street 1:1024 LIFFEY DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15901 CENTRAL COMMERCE DR
Practice Address - Street 2:SUITE 504
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2041
Practice Address - Country:US
Practice Address - Phone:512-251-1252
Practice Address - Fax:512-989-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1773261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205866548OtherNPI NUMBER
TX1773OtherSTATE LICENSE NUMBER
TXV09948Medicare UPIN