Provider Demographics
NPI:1487029617
Name:AVA K WASHKO DPM PLLC
Entity Type:Organization
Organization Name:AVA K WASHKO DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:WASHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-644-9798
Mailing Address - Street 1:9816 MEMORIAL BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4255
Mailing Address - Country:US
Mailing Address - Phone:832-644-9798
Mailing Address - Fax:832-777-1748
Practice Address - Street 1:9816 MEMORIAL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:832-644-9798
Practice Address - Fax:832-777-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3673303Medicaid
TX3488348Medicaid