Provider Demographics
NPI:1467958538
Name:SAN ANTONIO FOOT AND ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:SAN ANTONIO FOOT AND ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-644-4701
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1089
Mailing Address - Country:US
Mailing Address - Phone:210-644-4700
Mailing Address - Fax:210-644-4701
Practice Address - Street 1:11212 STATE HIGHWAY 151 STE 370
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4504
Practice Address - Country:US
Practice Address - Phone:210-664-4700
Practice Address - Fax:210-664-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1909213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherPENDING