Provider Demographics
NPI:1477526457
Name:EP FOOT CARE, PA
Entity Type:Organization
Organization Name:EP FOOT CARE, PA
Other - Org Name:EL PASO FOOTCARE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ASSOCIATION MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:915-751-0000
Mailing Address - Street 1:4659 COHEN AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4415
Mailing Address - Country:US
Mailing Address - Phone:915-751-0000
Mailing Address - Fax:915-751-0464
Practice Address - Street 1:4659 COHEN AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4415
Practice Address - Country:US
Practice Address - Phone:915-751-0000
Practice Address - Fax:915-751-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00770WMedicare ID - Type Unspecified
TX5049440001Medicare NSC