Provider Demographics
NPI:1427226711
Name:ATHENS FOOT AND ANKLE HEALTH AND SURGERY, PC
Entity Type:Organization
Organization Name:ATHENS FOOT AND ANKLE HEALTH AND SURGERY, PC
Other - Org Name:D. MATTHEW ALLEN, D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-675-1337
Mailing Address - Street 1:1123 S. PALESTINE ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3645
Mailing Address - Country:US
Mailing Address - Phone:903-675-1337
Mailing Address - Fax:903-675-4351
Practice Address - Street 1:1123 S. PALESTINE ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3645
Practice Address - Country:US
Practice Address - Phone:903-675-1337
Practice Address - Fax:903-675-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1533P213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146346501Medicaid
TX0067GROtherBCBS PROVIDER #
TX146346501Medicaid
TX0067GROtherBCBS PROVIDER #
TXU85178Medicare UPIN