Provider Demographics
NPI:1467655845
Name:HILL COUNTRY ADVANCED FOOT AND ANKLE CENTER, P.A.
Entity Type:Organization
Organization Name:HILL COUNTRY ADVANCED FOOT AND ANKLE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:JAMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-693-8144
Mailing Address - Street 1:1001 MARBLE HTS
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4543
Mailing Address - Country:US
Mailing Address - Phone:830-693-8144
Mailing Address - Fax:830-693-8145
Practice Address - Street 1:1001 MARBLE HTS
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4543
Practice Address - Country:US
Practice Address - Phone:830-693-8144
Practice Address - Fax:830-693-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467655845OtherNPI
TX1783805-01Medicaid
TX5593370004Medicare NSC
TX00710ZMedicare ID - Type UnspecifiedGROUP NUMBER